Clinical Consulting Manager
Netsmart
part-time
Posted on:
Location Type: Remote
Location: United States
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About the role
- Perform documentation review on medical records to identify clinical elements for accuracy
- Review client information systems for complete and accurate clinical documentation
- Research and provide comments and recommendations on complex or newly issued billing regulations
- 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 documentation associated with focused medical reviews and write appeals for denied services
- Provide denial support at the Administrative Law Judge (ALJ) level of appeals
- Participate in cross-team clinical consulting work
Requirements
- Associate’s Degree in nursing, social work, physical therapy or another related discipline
- Active and unrestricted license in related field
- At least 5 years of progressive clinical management experience
- At least 2 years quality assurance and/or case management experience
- In-depth knowledge of condition of participations and conditions of payment
- Extensive knowledge of regulatory standardized assessment documents and patient care protocols
- Proficient in Microsoft Office Suite including Excel, PowerPoint, and Word
Benefits
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Applicant Tracking System Keywords
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Hard Skills & Tools
clinical documentation reviewbilling regulations researchprocess improvement analysismedical review documentationappeals writingdenial supportquality assurancecase managementregulatory assessment knowledgepatient care protocols
Soft Skills
communicationanalytical thinkingproblem-solvingcollaborationpresentation skills
Certifications
Associate’s Degree in nursingAssociate’s Degree in social workAssociate’s Degree in physical therapyactive and unrestricted license