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For more than 50 years, we’ve been a healthcare software company developing technology and providing services in behavioral health, human services, and post-acute markets. We collaborate with organizations and partner with our clients across the care spectrum to anticipate challenges, identify obstacles, and recognize new opportunities as healthcare evolves. We continuously strive to advance our Netsmart technologies and offerings beyond the EHR by embracing new technology trends that empower healthcare professionals to provide the best possible care.
As a Clinical Consulting Manager, you will partner with clinical teams and organizational leaders to provide guidance, education, and operational support that strengthens care delivery, ensures regulatory compliance, and enhances the patient and family experience across home health and hospice services.
Responsibilities
Perform documentation review on medical records to identify clinical elements for accuracyÂ
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 Â
Research and provide comments and recommendations on complex or newly issued billing regulationsÂ
Conduct weekly calls with the client to present findings and results of the engagementÂ
Analyze trends and provide process improvement recommendations for clinical operational processes to improve quality of care and patient outcomesÂ
Review documentation associated with focused medical reviews and write appeals for denied services; provide denial support at the Administrative Law Judge (ALJ) level of appealsÂ
Participate in cross-team clinical consulting workÂ
Qualifications
Required
Associate’s Degree in nursing, social work, physical therapy or another related disciplineÂ
Active and unrestricted license in related field Â
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 protocolsÂ
Proficient in Microsoft Office Suite including Excel, PowerPoint, and WordÂ
Excellent written and verbal communication and presentation skills are requiredÂ
Preferred
Bachelor of Science in nursing (BSN), social work (MSW), physical therapy or another related discipline
Experience with Medicare contractor audits and appeals
Expectations
Comfortable with remote work arrangements and virtual collaboration tools Â
Physical demands include extended periods of sitting, computer use, and telephone communicationÂ
Position at times may include extended or irregular hours outside of traditional office hours to support clients and projects across multiple time zones Â
Travel up to 25% as neededÂ
Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate.
Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.
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All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position.
Netsmart's Job Applicant Privacy Notice may be found here.
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