Clinical Central Review Associate

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🇺🇸 United States – Remote

💵 $75k - $85k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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BAYADA Home Health Care

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1975

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

BAYADA Home Health Care is a provider of a wide range of home health care services. The company offers personal care and companionship, home health services, adult private duty nursing, pediatric care, hospice care, habilitation, and therapy for autism and ABA. BAYADA operates internationally, with a presence in countries such as Germany, India, South Korea, Ireland, and New Zealand. It is accredited by the Community Health Accreditation Partner, ensuring it meets high industry standards. BAYADA also engages in partnerships for senior living solutions and supports a diverse range of clients with its comprehensive health care solutions.

📋 Description

• Learn all aspects of clinical management under the guidance of the Clinical Manager / Rehabilitation Manager and the Director • Participate in oversight of service delivery to ensure superior quality • Review clinical documentation for consistent, accurate, high-quality services • Work with MCM to ensure accurate ICD coding • Monitor episodic utilization according to care protocols • Assign appropriate clinicians to clients • Ensure documentation progresses from start of care to discharge • Support case management, including HHA and LPN supervision, authorization management, and interdisciplinary communication • Coordinate medical supplies with MCO and MCM • Act as internal case manager and client advocate • Participate in infection-control investigations and improvement planning • Respond to ADRs and denials • Assist with hiring, interviewing, orientation, competency observation, supervision, feedback, evaluations, and development of field staff • Liaise between field and office staff and communicate with Clinical Practice Leadership • Independently manage a caseload as directed • Provide clinical guidance to office colleagues and support administrative activities • Represent BAYADA in community and marketing activities • Participate in quality/performance improvement activities and office/company meetings • Transition into the Clinical Manager I role under guidance of a Clinical Manager Mentor • Answer phones, greet visitors, and generate correspondence as needed • Maintain knowledge of professional standards, BAYADA policies, procedures, and regulations • Pursue professional growth through continuing education and/or organizational membership

🎯 Requirements

• Holds a current license in good standing as a Registered Nurse, PT, OT, or ST • BSN / Master’s preferred and required based on state regulations • Graduate of an accredited and approved nursing program • Demonstrated record of strong interpersonal skills • Demonstrated record of goal achievement • Demonstrated ambition to take on more responsibility and grow past current position • Passing score on the appropriate nursing quiz and all required competency tests • Knowledge of the Medicare Conditions of Participation and other program requirements • Completed Nursing Skills Checklist appropriate to the client population • Completed criminal background and federal/state program exclusions checks • Completed continuing education requirements (CEUs) as required by regulation

🏖️ Benefits

• Bonus Opportunity available • Paid holidays • Vacation and sick leave • Vision, dental and medical health plans • Employer paid life insurance • 401k with company match • Direct deposit • Employee assistance program

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