RN Quality Review Manager, Home Health

BAYADA Home Health Care • Pennsauken Township, NJ

8d • $77,000 - $80,000 • Remote

About The Position

BAYADA Home Health Care has an immediate opening for a Full Time, Quality Reviewer with OASIS certification to work remotely. RN’s with certifications will be considered for this role. The Quality Reviewer is responsible for auditing, validating, and optimizing the patient’s Plan of Care (Form CMS-485) and OASIS assessments. This role ensures clinical accuracy, regulatory compliance with Medicare/CMS guidelines, and appropriate reimbursement for home health services.

Requirements

• Competency in PC skills required to perform job function
• Active Compact RN Nursing License, with a minimum of 2 years clinical experience.
• COS-C or HCS-O or COQS OASIS Certification and experience required

Nice To Haves

• HCHB experience, a plus!

Responsibilities

• Compare the CMS-485 against referral documents, History & Physical (H&P), OASIS, and therapy/nursing evaluations for 100% consistency and medical necessity.
• Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy.
• Provide support and communication to all disciplines within the service.
• Provide customer service/education and act as a resource to Medicare Certified Offices with regards to CMS guidelines, PDGM guidelines and billing related issues.
• Provide ongoing communication with service offices via e-mail, zoom, or telephone (specific to the service office needs).
• Communication with service offices monthly and as appropriate with a focus on documentation trends, star ratings and potential revenue impact.
• Perform related duties, or as required or requested by Manager/Director.

Benefits

• Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with company match, direct deposit, and employee assistance program.

What This Job Offers

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