Manager, Clinical Review Services

Mosai•Nashville, TN

7d•Hybrid

About The Position

Leads the team that performs OASIS assessment review and ICD-10 coding review for Mosai’s home health clients, with direct people leadership over employed OASIS Reviewers and ICD-10 Coders and ownership of the quality standard applied to all review work, including work performed by contracted consultants. May be client-facing; serves as the escalation point that resolves disputed findings, represents review methodology to client leadership, and absorbs the client relationship so reviewers can stay focused on production and accuracy. Owns the human-in-the-loop standard for Mosai’s AI-assisted review platform, defining and auditing the expectation that licensed clinicians validate platform findings against the source record, and serves as the clinical counterpart to product and engineering on platform accuracy.

Requirements

Active, unrestricted Registered Nurse (RN) license required.
Current COS-C (Certificate for OASIS Specialist – Clinical) or HCS-O (Home Care Clinical Specialist – OASIS) certification required at hire.
Minimum of 5 years of clinical experience in Medicare-certified home health required.
Minimum of 2 years of people leadership experience required, including hiring, performance management, and direct supervision of clinical staff.
Demonstrated experience in OASIS review, clinical QA, coding audit, or documentation integrity required.
Hands-on experience with one or more major home health EMR platforms required.
Deep command of OASIS conventions, item intent, and time point requirements sufficient to adjudicate disagreements between experienced reviewers, and the ability to lead a remote, distributed team across multiple clients, EMRs, and time zones.

Nice To Haves

BSN preferred; Associate’s degree in Nursing with equivalent leadership experience considered.
Multi-state licensure or Nurse Licensure Compact participation preferred.
Current HCS-D (Home Care Coding Specialist – Diagnosis) certification strongly preferred, given oversight of coding review work and audit of coding deliverables; BCHH-C or COQS considered as equivalents.
Experience designing or running a clinical quality audit or calibration program strongly preferred; prior experience in an outsourced, vendor, or multi-client service environment strongly preferred.
Experience managing or coordinating contract or contingent clinical staff preferred.
Experience with Homecare Homebase preferred.
Experience with clinical software, decision support, or AI-assisted review tools preferred.

Responsibilities

Recruit, interview, hire, and onboard OASIS Reviewers and ICD-10 Coders, verifying licensure and required credentials and supervising ramp on live review work to a defined accuracy threshold before independent assignment.
Conduct one-on-ones, deliver performance feedback and reviews, manage underperformance through documented improvement plans, and coach reviewers on the quality of written recommendations.
Define, document, and maintain the review accuracy standard, audit methodology, and sampling approach; run a recurring quality audit program across employees and contractors with findings, trending, and documented corrective action.
Facilitate calibration and inter-reviewer reliability exercises, investigate and resolve inconsistent findings between reviewers, and maintain the review playbook and client-specific parameter documentation.
Monitor platform override rates and own the human-in-the-loop policy for AI-assisted review, holding the team accountable to independent validation of every platform finding; serve as clinical point of contact to product and engineering, aggregating feedback and providing clinical sign-off on platform changes.
Forecast review volume, allocate work across employees and contractors to meet contracted turnaround commitments, match assignments to credentials held, and escalate capacity shortfalls before they affect client billing.
Serve as the escalation point for disputed findings, explaining clinical rationale and applicable CMS guidance to client clinical leadership, and represent review methodology and quality standards in client business reviews and onboarding.
Maintain a credentialed consultant pool, match contract assignments to credentials and client scope, audit contractor deliverables against the same accuracy standard applied to employees, and coordinate with legal, compliance, and finance on contractor agreements — without directing a consultant’s hours, schedule, or method of performing review.
Oversee client EMR access provisioning and deprovisioning, audit access and activity logs, ensure required security, HIPAA, and compliance training is completed before client work begins, and escalate suspected privacy incidents or unauthorized access immediately.
Maintain current expertise in OASIS guidance, PDGM, CMS Conditions of Participation, HH QRP, HHVBP, and ICD-10-CM coding for home health, and own the process for absorbing guidance and code set changes into team standards, training, and platform logic.