Requisition: 2024-134247

　　Utilization Review Supervisor

　　Job LocationsUS-KY-LOUISVILLE

　　Our CompanyBrightSpring Health Services

　　OverviewThe Home Health Utilization Review Supervisor will manage and conduct Utilization Review activities to include, but not limited to, ICD-10 coding and OASIS recommendations for BrightSpring Health Services' (BSHS) Centralized Coding Team while complying with all company policies and procedures. The Supervisor will assist the company in ensuring accurate ICD-10 coding and OASIS recommendations per state and federal regulations and guidelines; establishes and implements utilization review and coding practices and is accountable to ensure excellent clinical and financial outcomes.

　　ResponsibilitiesSupervises day-to-day activities of the Utilization Review Specialists and Utilization Review Coders, including hiring, performance management via monthly QA/Inter-Rater Reliability audits, as well as education and training with industry updates or as the need is identified

　　Identifies areas for improvement and follows up as needed with appropriate staff; responds timely to inquiries to resolve any ICD-10 coding or OASIS review questionsWorks with all branches to assure accuracy with ICD-10 coding and OASIS recommendations are provided by our team members and provides feedback to branch clinical staff regarding areas with opportunities for improvement relating to clinical documentation that would accurately reflect each patient's condition and would support payer requirementsProvides staff training for new UR initiatives and monitors their individual performance for their assigned branches via monthly QA audits; adherence to coding team processes, communication style and professionalism, and other methods as deemed necessaryWorks with regional and divisional leadership to develop and implement best practices for documentation related to ICD-10 coding and OASIS for home health and ICD-10 coding for hospiceParticipates in the development of company UR guidelines and protocolsPrepares and provides reporting on branch ICD-10 codingIdentifies clinical strategies for impacting branch OASIS and ICD-10 coding and makes recommendations for changes to policies, practices and processes.Collaborates with BSHS and agency leadership to develop clinical strategies and implements UR processes and best practices to achieve company clinical and financial objectivesKeeps current with pertinent industry utilization, ICD-10 coding and OASIS practice standards and guidelines for both payers, as well as providers, and ensures all applicable processes are in alignment with BSHS processes and standardsReviews OASIS assessment documents and ICD-10 diagnosis coding at individual branch locations to ensure consistent application and follow throughParticipates in educating branch and regional staff in best documentation practices and protocols of care that drive excellent clinical outcomes, as well as ensuring accurate financial reimbursement for services providedWorks with all assigned locations to ensure accurate ICD-10 coding and a modified OASIS review is completed per BSHS policies and proceduresProvides staff training for new Utilization Review initiatives and monitors the performance of the branchesCollaborates as necessary with leadership to develop clinical strategies and implements processes and practices that achieve BSHS clinical and financial objectivesEstablishes and promotes positive, ongoing communication within the Centralized Coding Team, as well as all company personnelPerforms other related duties as assigned or requested

　　QualificationsCurrent R.N. licensure required and must be maintained; Bachelor's degree preferredFive (5) years of professional experience preferred in home health and/or hospiceThree (3) years supervisory or leadership and/or QA experience in home health or hospice preferredAbility to work a flexible schedule and extended hours on occasionCurrent ICD-10 home health coding certification required; must be maintainedCurrent OASIS home health certification required; must be maintainedProficient in basic computer skills with Windows and Word; must read, write and speak fluent EnglishExcellent understanding of OASIS and ICD-10 coding practices, along with a strong knowledge of home health and hospice regulationsDemonstrates excellent verbal, written, and critical thinking skills; must be able to be proactive and work well under pressure to meet deadlines and company needsDemonstrates organizational and multi-tasking skills, as well as professionalism and discretion, with the ability to work well with others in a work environment; must also demonstrate the ability to work independently; must be proactive, responsive and resourceful

　　About our Line of BusinessBrightSpring Health Services is a leading provider of complementary home and community-based pharmacy and health services for complex populations in need of chronic and/or specialized care. Through the company's pharmacy and provider services to seniors and specialty (including behavioral) populations, we provide comprehensive care and clinical services in 50 states to over 360,000 customers, clients and patients daily. The company's services foster greater patient and family satisfaction, improve outcomes and reduce health care system costs, and are supported by industry-leading quality outcomes. For more information, visitwww.brightspringhealth.com. Follow us onFacebook,TwitterandLinkedIn.

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　　Res-Care, Inc., dba BrightSpring Health Services (“ResCare”), is an Equal Opportunity Employer. ResCare does not discriminate against any person on the basis of gender, r ace, color, national origin, r eligion, disability, age, veteran status, gender identity or s exual orientation in admission, treatment, or participation in its programs, services and activities, or in employment, or on the basis of gender in its health programs and activities.