Clinical Central Review Associate

This is a fully remote position, open to applicants in United States.

📋 Description

• Acquire comprehensive knowledge of clinical management under the mentorship of the Clinical Manager / Rehabilitation Manager and the Director.

• Engage in the oversight of service delivery to guarantee exceptional quality.

• Examine clinical documentation to uphold consistency, accuracy, and high-quality services.

• Collaborate with MCM to ensure precise ICD coding.

• Track episodic utilization in accordance with care protocols.

• Allocate suitable clinicians to clients.

• Ensure documentation progresses seamlessly from the initiation of care to discharge.

• Assist in case management, which includes supervising HHA and LPN, managing authorizations, and facilitating interdisciplinary communication.

• Coordinate medical supplies with MCO and MCM.

• Serve as the internal case manager and advocate for clients.

• Take part in infection control investigations and planning for improvements.

• Address ADRs and denials.

• Aid in the recruitment process, including hiring, interviewing, orientation, competency observation, supervision, feedback, evaluations, and development of field staff.

• Act as a liaison between field and office staff while communicating with Clinical Practice Leadership.

• Manage a caseload independently as directed.

• Offer clinical guidance to office colleagues and assist with administrative tasks.

• Represent BAYADA in community outreach and marketing initiatives.

• Engage in quality/performance improvement activities and participate in office/company meetings.

• Transition into the Clinical Manager I position under the mentorship of a Clinical Manager Mentor.

• Answer phone calls, welcome visitors, and produce correspondence as necessary.

• Stay informed about professional standards, BAYADA policies, procedures, and regulations.

• Pursue professional development through continuing education and/or organizational memberships.

⛳️ Requirements

• Must possess a current license in good standing as a Registered Nurse, PT, OT, or ST.

• BSN / Master’s degree is preferred and may be required based on state regulations.

• Graduate of a recognized and accredited nursing program.

• Proven track record of strong interpersonal skills.

• Demonstrated history of achieving goals.

• Display ambition to assume greater responsibilities and advance beyond the current role.

• Achieve a passing score on the relevant nursing quiz and all mandatory competency assessments.

• Familiarity with the Medicare Conditions of Participation and other program requirements.

• Completion of the Nursing Skills Checklist relevant to the client population.

• Successful completion of criminal background checks and federal/state program exclusions checks.

• Fulfillment of continuing education requirements (CEUs) as mandated by regulation.

🏝️ Benefits

• Opportunity for bonuses available.

• Paid holidays.

• Vacation and sick leave.

• Vision, dental, and medical health plans.

• Employer-paid life insurance.

• 401k plan with company match.

• Direct deposit available.

• Employee assistance program.