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 management of caseload at the discretion of the Director and / or Manager guiding mentoring process.
• Support the team (office and company).
  • Provide clinical guidance and judgment to office colleagues to promote understanding of and response to client’s needs.
  • Work in a coordinated effort with Client Service Manager/Associate
  • Fill-in to support the field staff when staffing is unavailable.
  • Work with the team to support all administrative support activities such as filing and office upkeep.
  • Represent BAYADA in community and marketing activities.
  • Participate in Quality / Performance Improvement activities.
  • Participate in office and company meetings, events and functions.
• Demonstrate solid performance or exceed performance standards in key job dimensions/attributes as defined on the Performance Appraisal for Office Staff.
• Perform related duties as required or requested by supervisor:
• Transition into Clinical Manager I role under direct guidance of Clinical Manager Mentor.

OTHER RESPONSIBILITIES:

• Together with entire office staff, answer phones, greet visitors and generate correspondence as necessary for office needs.
• Maintain current knowledge of, and follow standards of practice, BAYADA policies and procedures, and regulations (government, contract, accrediting body).
• Strive continually for professional growth and development through continuing education and/or organizational membership.

BAYADA believes our employees are our greatest asset:

• Base Salary: $75,000 - $85,000 / year depending on qualifications
• Bonus Opportunity available
• BAYADA offers a comprehensive benefits plan that includes the following: Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct deposit and employee assistance program
• To learn more about BAYADA Benefits, click here