Res-Care, Inc.

UTILIZATION REVIEW SPECIALIST - RN

Source: Lensa

Our Company

BrghtSp

ring

Overview

Our operational team members focus on efficiently meeting the needs of our clients across various lines of business. If your passion is to ensure quality care to help our clients live their best life we encourage you to apply today!

Responsibilities

  • The Home Health Utilization Review Specialist (URS) conducts Utilization Review and ICD-10 Coding activities for area of responsibility, complying with company's policies and procedures. Assists company in ensuring accurate OASIS and ICD-10 coding recommendations per coding regulations and guidelines, as well as excellent clinical outcomes
  • Works with all assigned locations to ensure accurate ICD-10 coding and a modified OASIS review is completed per the company's policies and procedures
  • Reviews OASIS assessment documents and ICD-10 coding and provides feedback to clinical staff regarding areas in need of improvement relating to clinical documentation that accurately reflects the patients condition and needs to support payer requirements
  • Works with management as requested to develop and implement best practices for documentation and coding of Home Health and Hospice services
  • Provides staff training for new Utilization Review initiatives and monitors the performance of assigned branches
  • Participates in the development of company Utilization Review guidelines and protocols
  • Prepares and provides reporting on ICD-10 coding and OASIS reviews. Identifies clinical strategies for impacting branch OASIS and ICD-10 coding and makes recommendations for changes to policy, practices and processes
  • Collaborates with necessary management teams to develop clinical strategies and implements processes and practices that achieve the company's clinical and financial objectives
  • Keeps abreast of pertinent industry utilization, coding and OASIS coding practice standards
  • Participates in educating branch and regional staff in best documentation practices and protocols of care that drive both excellent clinical outcomes, as well as ensuring accurate financial reimbursement for services provided
  • Identify problems and follows up as needed with appropriate staff; responds timely to answer and/or resolve any coding or OASIS review questions
  • Establishes and promotes positive, ongoing communication with company personnel

Qualifications

  • Current Registered Nurse licensure required; Bachelors degree preferred
  • Current ICD-10 Home Health coding certification required; must be maintained
  • Current OASIS Home Health certification required; must be maintained
  • Five years of professional experience preferred in Home Health and/or Hospice
  • Excellent understanding of OASIS and ICD-10 coding practices, along with a strong knowledge of Home Health and/or Hospice regulations
  • Demonstrates excellent verbal, written, and critical thinking skills; must be able to be proactive and work well under pressure to meet deadlines and company needs
  • Demonstrates organizational and multi-tasking skills, as well as professionalism and discretion, with the ability to get along well with others in a work environment; must also demonstrate the ability to work independently; must be proactive, responsive and resourceful
  • Proficient in basic computer skills and Word; must read, write and speak fluent English
  • Must possess the ability to work a flexible schedule and extended hours on occasion
  • Must have current drivers license and have reliable transportation and insurance

About our Line of Business

BrightSpring Health Services is the leading provider of complementary pharmacy, and comprehensive home and community-based health services for complex populations in need of specialized care. Through the company's eleven lines of business including home care, hospice, community living, behavioral health, family and youth, pharmacy, neuro rehabilitation, home health, applied behavior analysis and workforce development, the focus is on providing comprehensive care services, specialized care and clinical services to patients nationwide. For more information, visit www.brightspringhealth.com. Follow us on Facebook, Twitter and LinkedIn.

Colorado Pay Min

Colorado Pay Max


48 minutes ago

Louisville, Ky

Res-Care, Inc.

Full Time

Apply at Uzoes
By registering, you are giving consent for uzoes to inform you of jobs by email according to your search. I declare that I have read and accept the Terms of Service , Privacy Policy and Cookies Policy of beBee Affinity Social Network SL

Related Jobs

  • https://dktn8eak9qti5.cloudfront.net/img/letters/B.png

    UTILIZATION REVIEW SPECIALIST - RN

    Our Company BrghtSp ring Overview Our operational team members focus on efficiently meeting the needs of our clients across various lines of business. If your passion is

    BrightSpring Health Services - Louisville, Ky - Starwire

  • https://dktn8eak9qti5.cloudfront.net/img/letters/S.png

    Utilization Review Nurse

    Signature HealthCARE is a family-based healthcare company that offers integrated services in 10 states across the continuum of care: skilled nursing, rehabilitation, assisted living, memory care, home

    Signature Healthcare - Louisville, Ky - Lensa

  • https://dktn8eak9qti5.cloudfront.net/img/letters/B.png

    UTILIZATION REVIEW CODER

    Our CompanyBr ghtSp ring OverviewOur operational team members focus on efficiently meeting the needs of our clients across various lines of business. If your passion is to ensure quality care to help

    BrightSpring Health Services - Louisville, Ky - Lensa

  • https://dktn8eak9qti5.cloudfront.net/img/letters/H.png

    RN - Utilization Review -WAH Telephonic - Medicare - SE Region

    **Description** The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determ

    Humana - Louisville, Ky - Lensa