Clinical Central Review Associate

Location: Remote (Central/Mountain/Pacific/Hawaii Region) POSITION SUMMARY: Responsible to learn all aspects of clinical management under the guidance of the Clinical Manager / Rehabilitation Manager and the Director. MINIMUM QUALIFICATIONS: • Exemplifies characteristics of The BAYADA Way: compassion, excellence, and reliability. • Holds a current license in good standing as a Registered Nurse. PT, OT, or ST. BSN / Master’s preferred and required based on state regulations. • Graduate of an accredited and approved nursing program. • Demonstrated record of strong interpersonal skills. • Demonstrated record of goal achievement. • Demonstrated ambition to taking on more responsibility and grow past current position. • Achieves a passing score on the appropriate nursing quiz and all required competency tests appropriate to the type of cases that they will be supervising. • Demonstrated knowledge of the Medicare Conditions of Participation and other program requirements. • Completed Nursing Skills Checklist demonstrating knowledge and skills appropriate to age range of client population. • Completed criminal background and federal/state program exclusions checks. • Completed Continuing Education Requirements (CEUs) as required by regulation. PRIMARY RESPONSIBILITIES: • Demonstrate and communicate the core values of BAYADA Home Health Care and The BAYADA Way. • Participate in the oversight of the delivery of all services to ensure superior quality, under guidance of the Clinical Manager / Rehabilitation Manager. • Review all clinical documentation to ensure consistent, accurate, high-quality services. • Work with MCM to ensure accurate ICD coding. • Monitor episodic utilization to ensure care is being delivered according to consistent protocols. • Work with other office team members to ensure that the most appropriate clinicians are assigned to each client. • Ensure that all documentation progresses efficiently through each stage of the care delivery process, from start of care to discharge. • Work with the field staff to ensure accurate and timely case management, including HHA and LPN supervision, authorization management, and interdisciplinary communication. • Coordinate the delivery of medical supplies with MCO and MCM. • Act as internal case manager and client advocate. Communicate and collaborate with team members regarding client status, care plan and expected outcomes. • Participate in the Infection Control Program by identifying and reporting infections and risks. Conduct investigation for infection trends and practice issues. Develop an action plan for improvement as needed. • Work with the office staff team to respond to ADRs and denials. • Assist Clinical Manager / Rehabilitation Manager in providing clinical oversight to field staff. • Participate in the hiring of field staff and interview process, as applicable. • Observe and confirm the competency of field staff. • Participate in new hire orientations and client-specific orientations to client care, safety precautions, procedures and treatments, documentation, and BAYADA policies and practices – both in the office and home, as applicable. • Supervise field staff through observing care rendered in the home and through review of documentation. • Provide feedback to employees including recognition, counseling and termination of employment. • Complete regular field staff performance evaluations with clinical manager and client services manager’s input. • Participate in the on-going education and development of field staff. • Function as a liaison between field and office staff. • Communicate with Clinical Practice Leadership in regard to client care issues, policies and procedures, and utilization of clinical resources. • Independent mana