Team Lead, UCA Reviewer

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

Job Summary

The Team Lead, Assessment Review & Submission, supervises a team of RN Reviewers who review and submit assessments for quality and compliance measures and applies their knowledge of Mass Health Rating Categories and compliance standards to ensure the reviews are completed timely and efficiently.

Essential Functions

• Hires and onboards assessment review nurses and provides ongoing training regarding standard operating procedures and quality assessments, tracks, and monitors team productivity.
• Maintains expert knowledge of the MA assessment process and how it is used to measure function leading to rating categories that support member needs and related costs.
• Ensures adequate training and technology is made available for nurses reviewing MDS visits.
• Works closely with the Manager, Assessment Review & Submission to balance nurse workload and ensures that assessments and being submitted on time and are of consistently high quality.
• Reviews a limited number of assessment visits, developing and disseminating best practices regarding assessment completion and patient assessment experience.
• Regularly collaborates to improve workflow and attain team objectives
• Reviews Assessments for training and quality assurance purposes
• Works closely with the Senior Management to identify and review downgrades for potential assessment errors, as well as identify and review potential rating category upgrades
• Analyzes claims, medical records, and assessment data to identify members that may be assigned to an inappropriate rating category; and recommends members for status change assessment, as appropriate.
• Continually looks for opportunities to improve knowledge of rating category requirements and assessment documentation to support assigned rating categories.
• Perform any other job related duties as requested.

Education and Experience

• Associates degree in Nursing required
• Bachelor's degree in Nursing preferred
• Two (2) years of experience completing MDS assessments required
• Two (2) years with electronic medical records required
• Prior supervisory experience preferred
• experience developing documentation of processes preferred

Competencies, Knowledge and Skills

• Strong knowledge of UCA assessment tool
• Strong oral and written communication skills
• Excellent analytical and organizational skills
• Effective teaching skills
• Excellent technology skills, including use of electronic health records and Microsoft Excel
• Able to function effectively as part of a team
• Ability to translate complex concepts into understandable guidelines preferred

Licensure and Certification

• Current Registered Nurse (RN) license in Massachusetts in good standing required

Working Conditions

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Salary

$72,200.00 - $115,500.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

Equal Opportunity Statement

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.