Clinical Central Review Associate

BAYADA Home Health Care•Houston, TX

4d•Remote

About The Position

The Clinical Central Review Associate learns all aspects of clinical management under the guidance of the Clinical Manager / Rehabilitation Manager and the Director. The role supports oversight of service delivery, clinical documentation, case management, field staff, and client care, with the opportunity to transition into a Clinical Manager I role under the direct guidance of a Clinical Manager Mentor. This position is remote in the Central/Mountain/Pacific/Hawaii region. The base salary is $75,000–$85,000 per year, depending on qualifications, with a bonus opportunity. BAYADA offers paid holidays, vacation and sick leave, vision, dental and medical health plans, employer-paid life insurance, a 401(k) with company match, direct deposit, and an employee assistance program.

Requirements

Current license in good standing as a Registered Nurse, PT, OT, or ST.
Graduate of an accredited and approved nursing program.
BSN / Master’s degree where required by state regulations.
Demonstrated strong interpersonal skills.
Demonstrated record of goal achievement.
Demonstrated ambition to take on more responsibility and grow beyond the current position.
Passing score on the appropriate nursing quiz and all required competency tests for the types of cases supervised.
Knowledge of Medicare Conditions of Participation and other program requirements.
Completed Nursing Skills Checklist demonstrating knowledge and skills appropriate to the client population’s age range.
Completed criminal background and federal/state program exclusion checks.
Completed continuing education requirements (CEUs) as required by regulation.

Nice To Haves

BSN / Master’s degree is preferred, subject to state regulatory requirements.

Responsibilities

Demonstrate and communicate the core values of BAYADA Home Health Care and The BAYADA Way.
Participate in oversight of service delivery to ensure superior quality under the guidance of the Clinical Manager / Rehabilitation Manager.
Review clinical documentation for consistency, accuracy, and quality.
Work with MCM to ensure accurate ICD coding and monitor episodic utilization for adherence to consistent care protocols.
Coordinate with office team members to assign appropriate clinicians to clients and move documentation efficiently from start of care through discharge.
Work with field staff on case management, including HHA and LPN supervision, authorization management, and interdisciplinary communication.
Coordinate medical supply delivery with MCO and MCM.
Act as an internal case manager and client advocate; communicate and collaborate with team members about client status, care plans, and expected outcomes.
Participate in the Infection Control Program by identifying and reporting infections and risks, investigating trends and practice issues, and developing improvement plans as needed.
Work with office staff to respond to ADRs and denials.
Assist the Clinical Manager / Rehabilitation Manager with clinical oversight of field staff.
Participate in field staff hiring and interviews, as applicable; observe and confirm staff competency.
Participate in new-hire and client-specific orientations covering client care, safety precautions, procedures and treatments, documentation, and BAYADA policies and practices.
Supervise field staff by observing care in the home and reviewing documentation; provide employee feedback, including recognition, counseling, and termination of employment.
Complete regular field staff performance evaluations with input from the clinical manager and client services manager.
Participate in ongoing education and development of field staff and function as a liaison between field and office staff.
Communicate with Clinical Practice Leadership about client care issues, policies and procedures, and use of clinical resources.
Manage a caseload independently at the discretion of the Director and/or Manager guiding the mentoring process.
Support the office and company team, provide clinical guidance to office colleagues, and coordinate with Client Service Manager/Associate Fill-in to support field staff when staffing is unavailable.
Support administrative activities such as filing and office upkeep; represent BAYADA in community and marketing activities.
Participate in Quality / Performance Improvement activities and office and company meetings, events, and functions.
Meet or exceed performance standards in key job dimensions and attributes defined on the Performance Appraisal for Office Staff.
Perform related duties as required or requested by the supervisor, including transitioning into a Clinical Manager I role under direct guidance of a Clinical Manager Mentor.
Together with office staff, answer phones, greet visitors, and generate correspondence as needed.
Maintain current knowledge of and follow standards of practice, BAYADA policies and procedures, and government, contract, and accrediting-body regulations.
Pursue professional growth and development through continuing education and/or organizational membership.