Our Company

　　BrightSpring Health Services

　　Overview

　　The 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.

　　Responsibilities

　　Supervises 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 questions

　　Works 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 requirements

　　Provides 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 necessary

　　Works 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 hospice

　　Participates in the development of company UR guidelines and protocols

　　Prepares and provides reporting on branch ICD-10 coding

　　Identifies 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 objectives

　　Keeps 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 standards

　　Reviews OASIS assessment documents and ICD-10 diagnosis coding at individual branch locations to ensure consistent application and follow through

　　Participates 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 provided

　　Works with all assigned locations to ensure accurate ICD-10 coding and a modified OASIS review is completed per BSHS policies and procedures

　　Provides staff training for new Utilization Review initiatives and monitors the performance of the branches

　　Collaborates as necessary with leadership to develop clinical strategies and implements processes and practices that achieve BSHS clinical and financial objectives

　　Establishes and promotes positive, ongoing communication within the Centralized Coding Team, as well as all company personnel

　　Performs other related duties as assigned or requested

　　Qualifications

　　Current R.N. licensure required and must be maintained; Bachelor’s degree preferred

　　Five (5) years of professional experience preferred in home health and/or hospice

　　Three (3) years supervisory or leadership and/or QA experience in home health or hospice preferred

　　Ability to work a flexible schedule and extended hours on occasion

　　Current ICD-10 home health coding certification required; must be maintained

　　Current OASIS home health certification required; must be maintained

　　Proficient in basic computer skills with Windows and Word; must read, write and speak fluent English

　　Excellent understanding of OASIS and ICD-10 coding practices, along with a strong knowledge of home health and 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 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 Business

　　BrightSpring 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, visit www.brightspringhealth.com. Follow us on Facebook (https://www.facebook.com/brightspringHS/) , Twitter (https://www.twitter.com/BrightSpringHS/) and LinkedIn (https://www.linkedin.com/company/brightspringhealth/) .

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　　ALERT: We are aware of a scam whereby imposters are posing as employees from our company. Beware of anyone requesting financial or personal information. We take pride in creating a best-in-class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card, driver’s license, bank information, or payment for work equipment, etc.) from you via text or email. If you are suspicious of a job posting or job-related email mentioning our company, please contact us at [email protected] .

　　Click here (https://www.brightspringhealth.com/careers/frequently-asked-questions/) for additional FAQ information.

　　Job LocationsUS-KY-LOUISVILLE

　　ID 2024-134247

　　Line of Business BrightSpring Health Services

　　Position Type Full-Time