RN Assessment Review Team Lead - Quality & Compliance

CareSource; Boston (MA); On-site; USD 72,000 - 116,000; Full time

Job summary

CareSource in Boston, MA seeks a Team Lead, Assessment Review & Submission to supervise RN reviewers who evaluate and submit assessments for quality and MA rating category compliance. You will guide training, monitor productivity, and ensure timely, accurate submissions.

The role requires RN licensure in Massachusetts, 2+ years in MDS assessments, and EMR experience; supervisory work is preferred. A strong focus on process improvement and collaboration is essential.

Qualifications

• Associates degree in Nursing required.
• Bachelor's degree in Nursing preferred.
• Two years of experience completing MDS assessments required.
• Two years with electronic medical records required.
• Prior supervisory experience preferred.
• Experience developing documentation of processes preferred.

Responsibilities

• Hires and onboards assessment review nurses and provides ongoing training regarding procedures and quality assessments.
• Maintains expert knowledge of the MA assessment process and how it supports member needs and costs.
• Ensures nurses reviewing MDS visits have training and technology available.
• Balances nurse workload with the Manager, Assessment Review & Submission to ensure timely, high-quality submissions.
• Reviews a limited number of assessment visits and disseminates best practices.
• Collaborates to improve workflow and attain team objectives.
• Reviews Assessments for training and quality assurance purposes.
• Identifies potential downgrades or upgrades in rating categories with management.
• Analyzes claims, medical records, and assessment data to flag inappropriate rating categories.
• Seeks opportunities to improve knowledge of rating category requirements and documentation.

Skills

UCA assessment tool

Oral & written communication

Analytical skills

Organizational skills

Teaching skills

Microsoft Excel

Teamwork

Translate complex concepts

Education

Associates degree in Nursing

Bachelor's degree in Nursing (preferred)

Tools

Electronic Medical Records (EMR)

UCA assessment tool (tool)

Job description

CareSource in Boston, MA seeks a Team Lead, Assessment Review & Submission to supervise RN reviewers who evaluate and submit assessments for quality and MA rating category compliance. You will guide training, monitor productivity, and ensure timely, accurate submissions.

The role requires RN licensure in Massachusetts, 2+ years in MDS assessments, and EMR experience; supervisory work is preferred. A strong focus on process improvement and collaboration is essential.