Note: The job is a remote job and is open to candidates in USA. Netsmart is a healthcare software company dedicated to improving care delivery in behavioral health, human services, and post-acute markets. They are seeking a Clinical Consulting Manager to support clinical excellence and quality outcomes in home health and hospice care, providing guidance and operational support to enhance patient care delivery.

Responsibilities

• Perform documentation review on medical records to identify clinical elements for accuracy
• Perform post-acute home health and or hospice documentation review on medical records to identify clinical elements for accuracy
• Research and provide comments and recommendations on complex or newly issues home health and or hospice billing regulations
• Review client information systems for complete and accurate clinical documentation
• Research and provide comments and recommendations on complex or newly issued billing regulations
• Conduct weekly calls with the client to present findings and results of the engagement
• Analyze trends and provide process improvement recommendations for clinical operational processes to improve quality of care and patient outcomes
• Review documentation associated with focused medical reviews and write appeals for denied services; provide denial support at the Administrative Law Judge (ALJ) level of appeals
• Participate in cross-team clinical consulting work

Skills

• Associate's Degree in nursing, social work, physical therapy or another related discipline
• Active and unrestricted license in related field
• At least 5 years of progressive post acute clinical management experience in home health and /or hospice
• Experience with case management in home health and/or hospice with progressive involvement in Quality Assurance activities
• In-depth knowledge of condition of participations and conditions of payment; extensive knowledge of regulatory standardized assessment documents and patient care protocols
• Proficient in Microsoft Office Suite including Excel, PowerPoint, and Word
• Excellent written and verbal communication and presentation skills are required
• Bachelor of Science in nursing (BSN), social work (MSW), physical therapy or another related discipline
• Experience with Medicare contractor audits and appeals

Benefits

• Comfortable with remote work arrangements and virtual collaboration tools
• Travel up to 25% as needed
• Pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense

Company Overview