Team Lead, UCA Reviewer

🔥 13 hours ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

💵 $72.2k - $115.5k / year

⏰ Full Time

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Supervise a team of RN Reviewers who review and submit assessments for quality and compliance measures • Hire and onboard assessment review nurses and provide ongoing training on standard operating procedures and quality assessments • Track and monitor team productivity • Maintain expert knowledge of the Massachusetts assessment process and its use in measuring function and rating categories • Ensure adequate training and technology are available for nurses reviewing MDS visits • Balance nurse workload with the Manager, Assessment Review & Submission • Ensure assessments are submitted on time and meet consistently high-quality standards • Review a limited number of assessment visits and develop and disseminate best practices • Collaborate regularly to improve workflow and attain team objectives • Review assessments for training and quality assurance • Identify and review downgrades for potential assessment errors and potential rating category upgrades with senior management • Analyze claims, medical records, and assessment data to identify inappropriate rating category assignments • Recommend members for status change assessment when appropriate • Improve knowledge of rating category requirements and assessment documentation • Perform other job-related duties as requested

🎯 Requirements

• Associates degree in Nursing required • Two (2) years of experience completing MDS assessments required • Two (2) years with electronic medical records required • Current Registered Nurse (RN) license in Massachusetts in good standing required • Strong knowledge of UCA assessment tool • Strong oral and written communication skills • Excellent analytical and organizational skills • Effective teaching skills • Excellent technology skills, including use of electronic health records and Microsoft Excel • Able to function effectively as part of a team • Bachelor's degree in Nursing preferred • Prior supervisory experience preferred • Experience developing documentation of processes preferred • Ability to translate complex concepts into understandable guidelines preferred

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Employee total well-being support