Manager, Clinical Review Services

Mosai

47d•Hybrid

About The Position

Leads the team responsible for OASIS assessment review and ICD-10 coding review for Mosai’s home health clients. The role directly manages employed OASIS Reviewers and ICD-10 Coders and owns the quality standard for all review work, including work completed by contracted consultants. The position may be client-facing and serves as the escalation point for disputed findings, represents review methodology to client leadership, and manages client relationships so reviewers can focus on production and accuracy. The manager owns the human-in-the-loop standard for Mosai’s AI-assisted review platform, defining and auditing expectations for licensed clinicians to validate platform findings against source records. The role also serves as the clinical counterpart to product and engineering on platform accuracy. This is a hybrid role based in Jacksonville or Nashville. Work is primarily sedentary in a remote or office setting, with extended computer and screen use. Occasional travel may be required for client meetings, team meetings, or industry conferences. The role has authority over review standards, staffing, and the quality program, but not over client clinical records, submissions, or clinical practice.

Requirements

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

Nice To Haves

BSN preferred; an Associate’s degree in Nursing with equivalent leadership experience is considered.
Multi-state licensure or Nurse Licensure Compact participation preferred.
Current HCS-D (Home Care Coding Specialist – Diagnosis) certification strongly preferred; 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; verify credentials and supervise their ramp-up on live review work until they meet a defined accuracy threshold.
Conduct one-on-ones, provide performance feedback and reviews, manage underperformance through documented improvement plans, and coach reviewers on written recommendations.
Define, document, and maintain review accuracy standards, audit methodology, and sampling approach; run recurring quality audits across employees and contractors and document findings, trends, and corrective actions.
Facilitate calibration and inter-reviewer reliability exercises, investigate and resolve inconsistent findings, 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, ensuring independent validation of every platform finding; act as clinical contact for product and engineering, aggregate feedback, and provide clinical sign-off on platform changes.
Forecast review volume and allocate work across employees and contractors to meet contracted turnaround commitments, match assignments to credentials, and escalate capacity shortfalls before they affect client billing.
Resolve disputed findings by explaining clinical rationale and applicable CMS guidance to client clinical leadership; 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 to employee quality standards, and coordinate with legal, compliance, and finance on contractor agreements without directing consultants’ hours, schedules, or review methods.
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 immediately escalate suspected privacy incidents or unauthorized access.
Maintain current expertise in OASIS guidance, PDGM, CMS Conditions of Participation, HH QRP, HHVBP, and ICD-10-CM coding for home health; incorporate guidance and code set changes into team standards, training, and platform logic.