Clinical Consulting Manager

🕒 2 days ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Netsmart

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1973

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

Healthcare Insurance • SaaS • Artificial Intelligence

Netsmart is a leading provider of comprehensive EHR solutions tailored for a wide range of care settings, especially in behavioral health, addiction treatment, autism, geriatrics, and intellectual and developmental disabilities. The company offers a range of software products that streamline operations, enhance care coordination, and promote value-based care across healthcare communities. In addition to EHRs, Netsmart provides technology solutions for care coordination, telehealth, population health management, and revenue cycle management, aiming to support the delivery of integrated and person-centered care. Their solutions are used in a variety of sectors including human services, post-acute care, and public health, making Netsmart a significant player in the healthcare technology industry.

📋 Description

• Perform documentation review on medical records to identify clinical elements for accuracy • Perform post-acute home health and or hospice documentation review on medical records to identify clinical elements for accuracy • Research and provide comments and recommendations on complex or newly issues home health and or hospice billing regulations • Review client information systems for complete and accurate clinical documentation • Research and provide comments and recommendations on complex or newly issued billing regulations • Conduct weekly calls with the client to present findings and results of the engagement • Analyze trends and provide process improvement recommendations for clinical operational processes to improve quality of care and patient outcomes • Review documentation associated with focused medical reviews and write appeals for denied services; provide denial support at the Administrative Law Judge (ALJ) level of appeals • Participate in cross-team clinical consulting work

🎯 Requirements

• Associate’s Degree in nursing, social work, physical therapy or another related discipline • Active and unrestricted license in related field • At least 5 years of progressive post acute clinical management experience in home health and /or hospice • Experience with case management in home health and/or hospice with progressive involvement in Quality Assurance activities • In-depth knowledge of condition of participations and conditions of payment; extensive knowledge of regulatory standardized assessment documents and patient care protocols • Proficient in Microsoft Office Suite including Excel, PowerPoint, and Word • Excellent written and verbal communication and presentation skills are required

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours • Paid time off • Remote work options