Responsible for providing clinical expertise in working with clients and internal operations experts.

Responsibilities

• Perform reviews of client medical records as instructed by scope of work

• Research and provide comments and recommendations on complex or newly issued billing regulations

• Perform documentation review on medical records to identify clinical elements for accuracy

• Conduct weekly calls with the client to present findings and results of the engagement

• Analyze trends and provide process improvement recommendations for clinical operational processes to improve quality of care and patient outcomes

• Review client information systems for clinical documentation

• Review documentation associated with focused medical reviews and write appeals for denied services as needed

• Provide denial support at the ALJ level of appeals

• Participate in cross-team clinical consulting work

Qualifications

Required

• Associate Degree in nursing, social work, physical therapy or another related discipline or relevant work experience

• Active license in related field

• At least 5 years of progressive clinical management experience

• At least 2 years experience in quality assurance and/or case management

• In-depth knowledge of condition of participations and conditions of payment. Extensive knowledge regulatory standardized assessment documents as well as patient care protocols

• Proficient in the use of Outlook, Excel, Word, and PowerPoint basic functionality

• Excellent written and oral communication and presentation skills are required

Preferred

• Bachelor of Science in nursing (BSN), social work, physical therapy or another related discipline

Expectations

• Potential travel up to 40% of the time as needed

• Position may at times require extended or irregular hours outside of traditional office hours to support clients and projects across multiple time zones and any required travel

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.

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