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Clinical Central Review Associate

1 hour, 10 minutes ago
United States
Full-time
Mid Level
Operations Specialist
Operations
Apply Now
BAYADA Home Health Care

BAYADA Home Health Care

BAYADA Home Health Care provides trusted clinical care and support services at home for all ages, offering 24/7 care with compassion, excellence, and reliability.

Health Care Providers & Services
5001+
Founded 1975
View All Jobs

Description

  • Support oversight of home health service delivery, documentation quality, utilization, coding, and care progression from start of care through discharge.
  • Coordinate with office and field teams to assign clinicians, manage cases and authorizations, supervise HHA and LPN services, and arrange medical supplies.
  • Serve as an internal case manager and client advocate, communicating client status, care plans, and expected outcomes with interdisciplinary teams.
  • Assist with clinical oversight of field staff through hiring, orientation, competency validation, home observations, documentation review, evaluations, feedback, and ongoing education.
  • Identify, report, investigate, and address infection-control risks, trends, and practice issues.
  • Respond to ADRs and denials and participate in quality and performance improvement activities.
  • Provide clinical guidance to office colleagues and act as a liaison between field and office staff.
  • Provide field coverage when staffing is unavailable and support office administrative activities as needed.
  • Represent BAYADA in community and marketing activities and participate in office and company meetings.
  • Transition into the Clinical Manager I role under mentorship from the Clinical Manager and/or Director.

Requirements

  • Current, unencumbered Registered Nurse, PT, OT, or ST license; BSN or master's degree as preferred or required by state regulations.
  • Graduation from an accredited, approved nursing program.
  • Knowledge of Medicare Conditions of Participation and other applicable program requirements.
  • Strong interpersonal skills, a demonstrated record of goal achievement, and ambition to assume increased responsibility.
  • Commitment to BAYADA's values of compassion, excellence, and reliability.
  • Passing score on the applicable nursing quiz and required case-specific competency assessments.
  • Completed Nursing Skills Checklist appropriate to the client population's age range.
  • Ability to complete required criminal background, federal/state program exclusion, and continuing education checks and requirements.
  • Maintain current knowledge of clinical standards of practice, BAYADA policies, and government, contract, and accrediting-body regulations.
  • Availability to work remotely within the Central, Mountain, Pacific, or Hawaii region.

Benefits

  • Base salary of $75,000–$85,000 per year, depending on qualifications.
  • Bonus opportunity.
  • Paid holidays, vacation, and sick leave.
  • Medical, dental, and vision health plans.
  • Employer-paid life insurance.
  • 401(k) with company match.
  • Employee assistance program.
  • Direct deposit.

Interested in this position?

Apply directly on the company website

Apply Now

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