Responsible for providing clinical expertise in working with clients and internal operational experts focused on the home health and hospice sectors
Responsibilities
- Conduct weekly location calls with the client to review findings from a review of open and closed period
- Research and provide comments and recommendations on identified at-risk periods of care as per engagement requirements
- Review client EHR for clinical documentation
- Recommend home health visits based on clinical documentation and interaction with the client
- Present weekly project progress reports to client leadership
- Prepare and present monthly project progress to client leadership
- Review client EHR for clinical documentation
- Research and provide comments and recommendations on newly issued or highly complex cases related to potential Low Utilization Payment Adjustments (LUPAs) or potential overutilization
- Analyze trends and provide recommendations for home health operational processes to improve quality of care and patient outcomes
- Identify opportunities to deliver strategies to improve individual client health and overall experience
- Drive continuous improvement efforts internally and on client-specific engagements
- Perform Medicare home health pre-bill reviews for compliance with regulations prior to claim submission. Write appeals for denied home health services
- Participate in cross team clinical consulting work including Medicare home health clinical compliance documentation reviews including but not limited to focused medical reviews related to ADR, RAC, ZPIC, UPIC, etc. as needed
Qualifications
Required
- Associate’s degree in nursing, physical therapy, occupational therapy or another related discipline
- Active and unrestricted license in related field
- At least 2 years of experience in home health quality assurance and performance improvement
- At least 2 years of progressive home health clinical management experience
- At least 1 year case management, concurrent review or utilization management work experience
- In-depth knowledge of conditions of participation (CoPs) and conditions of payment for Home Health, extensive knowledge of OASIS and Episode Management
- Proficiency in Microsoft Office Suite including Excel, PowerPoint, and Word
- Excellent written and oral communication and presentation skills are required
Preferred
- Bachelor of Science in nursing (BSN), Physical Therapy, or Occupational Therapy
Expectations
- Potential travel up to 25% of the time as needed
- Position may at times require extended or irregular hours outside of traditional office hours to support clients and projects across multiple time zones and any required travel
Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.
Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.
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What We Do
Netsmart designs, builds and delivers electronic health records (EHRs), solutions and services that are powerful, intuitive and easy-to-use. Our platform provides accurate, up-to-date information that is easily accessible to care team members in behavioral health, care at home, senior living and social services. We make the complex simple and personalized so our clients can concentrate on what they do best: provide services and treatment that support whole-person care.
By leveraging the powerful Netsmart network, care providers can seamlessly and securely integrate information across communities, collaborate on the most effective treatments and improve outcomes for those in their care. Our streamlined systems and personalized workflows put relevant information at the fingertips of users when and where they need it.
For 50 years, Netsmart has been committed to providing a common platform to integrate care. SIMPLE. PERSONAL. POWERFUL.
Our more than 2,200 associates work hand-in-hand with our 600,000+ users in more than 25,000 organizations across the U.S. to develop and deploy technology that automates and coordinates everything from clinical to financial to administrative.
