Clinical Central Review Associate

BAYADA Home Health Care•Houston, TX

5d•$75,000 - $85,000•Remote

About The Position

The Clinical Central Review Associate is responsible for learning all aspects of clinical management under the guidance of the Clinical Manager or Rehabilitation Manager and the Director. The role supports oversight of clinical services, reviews documentation, coordinates care and case management, and helps ensure services meet quality standards, regulations, and BAYADA policies. The associate works with office and field staff, clients, and clinical leadership, and may independently manage a caseload at the discretion of the Director or Manager guiding the mentoring process. The position includes a transition into a Clinical Manager I role under the direct guidance of a Clinical Manager Mentor. The position is remote for the Central, Mountain, Pacific, and Hawaii regions. The stated 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, Physical Therapist, Occupational Therapist, or Speech Therapist.
Graduate of an accredited and approved nursing program.
BSN or master's degree preferred; required where state regulations require it.
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 to be supervised.
Knowledge of Medicare Conditions of Participation and other program requirements.
Completed Nursing Skills Checklist demonstrating knowledge and skills appropriate to the age range of the client population.
Completion of criminal background and federal/state program-exclusion checks.
Completion of continuing education requirements (CEUs) as required by regulation.
Demonstrate the characteristics of The BAYADA Way: compassion, excellence, and reliability.

Responsibilities

Demonstrate and communicate BAYADA Home Health Care’s core values and The BAYADA Way.
Participate in oversight of service delivery to ensure superior quality under the guidance of the Clinical Manager or Rehabilitation Manager.
Review clinical documentation for consistent, accurate, high-quality services.
Work with MCM to ensure accurate ICD coding.
Monitor episodic utilization to help ensure care is delivered according to consistent protocols.
Coordinate with office team members to assign the most appropriate clinicians to clients.
Ensure documentation progresses efficiently through the care delivery process, from start of care through discharge.
Work with field staff on timely 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 infection trends and practice issues, and developing improvement action plans as needed.
Work with office staff to respond to ADRs and denials.
Assist the Clinical Manager or Rehabilitation Manager with clinical oversight of field staff.
Participate in field staff hiring and interviews, as applicable.
Observe and confirm field staff competency.
Participate in new-hire and client-specific orientations covering care, safety precautions, procedures and treatments, documentation, and BAYADA policies and practices, in the office and home as applicable.
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.
Serve as a liaison between field and office staff.
Communicate client-care issues, policies, procedures, and clinical-resource utilization to Clinical Practice Leadership.
Manage a caseload independently at the discretion of the Director and/or the Manager guiding the mentoring process.
Support the office and company team and provide clinical guidance and judgment to office colleagues regarding client needs.
Coordinate with the Client Service Manager or Associate and 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 in the Performance Appraisal for Office Staff.
Perform related duties as requested by a 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 prepare correspondence as needed.
Maintain 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.