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Clinical Regulatory Initiatives Manager

Amedisys | Corporate Remote TN USA | Full Time | Posted: 08/09/2022

Job Descriptiontop

Caregiving is our Calling
At Amedisys whether we're caring for patients directly or supporting those who do, each of us is a caregiver at heart. Every team member contributes to our mission of providing exceptional, clinically distinct care in the home to thousands of patients and families every day.
You'll join a mission-driven company dedicated to innovation, growth and supporting our frontline caregivers with the best and most up-to-date resources available so they can do what they do best.
If you're looking for a home with a Nationwide Company where you can put your skills and experience to work, make a difference every day and pursue your goals for the future, join our team.
What You Will Do
Responsible for providing guidance and oversight of clinical regulatory programs and/or initiatives.
  • Reviews/audits clinical documentation to assure all federal and state guidelines are met.
  • Works closely with local and regional leadership to assure issues identified with documentation are communicated in a timely manner.
  • Coordinates with the RBOM to assure documentation is submitted to the MAC for pre-claims review.
  • Responsible for the clinical review of the pre-claim request for all SOC/Recertifications to include the following components: a. Evidence that there is a valid FTF with supporting documentation present for each patient. b. Evidence that home-bound criteria 1 and 2 are found in documentation for each patient. c. Evidence in documentation that medical necessity is evident and there is a skilled need for home health services that includes all disciplines to assure all federal and state coverage guidelines are met.
  • Communicates documentation discrepancies with local and regional leadership to assure timely submission of supporting documentation.
  • Identifies trends with clinical documentation to assist with process improvement.
  • Works closely with the Regional BOM to assure documentation is submitted timely to the MAC for pre-claims review.
  • Maintains clinical tracking logs as needed or requested.
  • Works closely with the Rapid Response Team to assure education is provided as needed related to trends and issues.
  • Performs other duties as assigned.

  • Current, unencumbered license to practice as a Registered Nurse.
  • Five (5+) years' home health experience.
  • Knowledge of Medicare coverage guidelines.
  • Knowledge of OASIS and coding guidelines.
  • Knowledge of Condition of Participation for home care and state regulatory bodies.
  • Knowledge of care delivery documentation systems and related medical record documents.

  • Three (3+) year's management experience.

Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.
Benefits and More

Amedisys cares for our team members with the same commitment we have to our patients. This is reflected in the benefits we provide and the opportunities we make available to our team. Benefits for eligible employees include:
  • Paid Time Off and Paid Holidays
  • Comprehensive Health Insurance Benefits (medical, dental, vision)
  • Health Savings Account, Health Reimbursement Account, and Flexible Spending Account options
  • Life, Disability, and Other Voluntary Benefits
  • 401(k) Retirement Savings Plan with Company Matching Contributions
  • Discounted Employee Stock Purchase Plan
  • Continuing Education
  • Fleet car for eligible employees

Job Detailstop

Location Corporate Remote, TN, United States
Categories Legal

Location Maptop

Contact Informationtop

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Job Code 22008089

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