Mgr-RN Quality Review and Coding, Continuum of Care

SSM Health • IL-REMOTE, IL

2d • $82,867 - $132,579 • Remote

About The Position

We are looking for a nurse who possesses leadership and oversight of documentation quality processes for home health and hospice services. This role ensures consistent, high-quality clinical documentation and works collaboratively across teams to maintain compliance and support billing integrity. In this role you will be responsible for Oversee quality review of clinical documentation processes across home health and hospice Monitor front-end documentation workflows to ensure consistency, accuracy, and adherence to standards Lead and manage the coding team responsible for evaluating documentation for coding accuracy and billing integrity Partner with cross-functional stakeholders to identify risks and recommend process improvements impacting documentation and billing Support compliance initiatives and uphold organizational standards for documentation quality and integrity.

Requirements

• Bachelor’s degree in nursing required or equivalent years of experience and education
• Five years' experience in home health, hospice, post-acute, or other health related organization, with demonstrated leadership responsibility
• Constant use of speech to share information through oral communication.
• Constant standing and walking.
• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, reaching and keyboard use/data entry.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of smell to detect/recognize odors.
• Frequent use of hearing to receive oral communication, distinguish body sounds and/or hear alarms, malfunctioning machinery, etc.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Occasional lifting/moving of patients.
• Occasional bending, stooping, kneeling, squatting, twisting, gripping and repetitive foot/leg and hand/arm movements.
• Occasional driving.
• Rare crawling and running.
• State of Work Location: Illinois Driving Record - Motor Vehicle Report (MVR) And Driver License – State Issued And Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
• State of Work Location: Missouri Driving Record - Motor Vehicle Report (MVR) And Driver License – State Issued And Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Missouri Division of Professional Registration
• State of Work Location: Oklahoma Driving Record - Motor Vehicle Report (MVR) And Driver License – State Issued And Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)
• State of Work Location: Wisconsin Driving Record - Motor Vehicle Report (MVR) And Driver License – State Issued And Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services

Nice To Haves

• Experience in clinical documentation quality review, coding, or related healthcare operations
• Strong understanding of documentation standards, coding practices, and billing integrity
• Demonstrated ability to lead teams and manage performance in a complex healthcare environment
• Experience collaborating across departments to drive process improvement and risk mitigation
• Knowledge of home health and/or hospice operations

Responsibilities

• Identifies areas for process improvement and participates in the development, implementation, evaluation and monitoring of new processes for quality review and coding.
• Leads others during implementation of changes.
• Coordinates and communicates key issues, status, or other information with regional operational and system leaders.
• Collaborates with providers to promote quality outcomes for operations.
• Supports operations by problem identification and resolution, cost containment, implementation of new services, and systems/performance measures.
• Uses evidence-based research and best practice for improvement of patient care outcomes and clinician efficiency.
• Supports the review of Outcome and Assessment Information Set (OASIS) assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy.
• Utilizes OASIS variation or alert report when reviewing OASIS data and ensures applicable OASIS files are uploaded and shared to Center for Medicare and Medicaid Services (CMS) portal.
• Notifies organizational leadership of opportunities resulting from the OASIS reviews.
• Serves as subject matter expert for evaluation, management, procedural quality review and coding in assigned areas.
• Interacts with quality reviewers, coders, physicians, and other health care practitioners to ensure common understanding of coding and documentation, guidelines/principles, government and commercial payer rules and regulations.
• Acts as a resource to physicians, information technology, and quality review and coding teams regarding electronic health record templates and tools.
• Assists with template development and ongoing review to ensure templates facilitate streamlined workflow for physicians while also ensuring accurate code selection.
• Provides support to physicians as requested or deemed necessary, may be required to travel to provider.
• Provides oversight to ensure coders can abstract code and work charge/claim review, queues, and coding-related denials.
• Recruits, engages, develops, leads, and manages assigned staff.
• Performs other duties as assigned.

Benefits

• one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE)
• instant access to their earned, unpaid base pay (fees may apply) before payday
• upfront tuition coverage through FlexPath Funded for eligible team members

What This Job Offers

• Job Type: Full-time
• Career Level: Manager