UTILIZATION REVIEW SPECIALIST - RN

Our Company: BrightSpring Health Services 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 home and community-based health services for high-need, high-cost and complex populations who require specialized and/or chronic care. Through the company’s Provider and Pharmacy lines of business, we provide a unique set of comprehensive and specialized care capabilities and clinical services across all 50 states serving more than 330,000 patients and clients daily. For more information, visit www.brightspringhealth.com. Follow us on Facebook, Twitter and LinkedIn.