Team Lead, UCA Reviewer

CareSource; Massachusetts; On-site; USD 72,000 - 116,000; Full time

Job summary

CareSource in Massachusetts is seeking a Team Lead for Assessment Review & Submission to supervise a team of RN Reviewers who evaluate and submit MA health assessments for quality, compliance, and accurate rating categories.

You will hire and onboard nurses, provide ongoing training on procedures, monitor team productivity, and ensure timely submissions with high-quality results. MA RN licensure required; 2+ years in MDS assessments and EMR experience preferred.

Qualifications

• Associates degree in Nursing required.
• Two years of experience completing MDS assessments required.
• Two years with electronic medical records required.
• Prior supervisory experience preferred.

Responsibilities

• Hires and onboards assessment review nurses and provides ongoing training.
• Maintains expert knowledge of the MA assessment process for rating categories.
• Ensures timely and high-quality assessment submissions.
• Collaborates to improve workflow and team objectives.
• Analyzes claims, medical records, and assessment data for appropriate rating changes.

Skills

RN Review tooling knowledge

Oral communication

Written communication

Analytical skills

Organizational skills

Team leadership

Excel

EMR systems

Education

Associate degree in Nursing

Bachelor's degree in Nursing

Tools

UCA assessment tool

Electronic Medical Records

Microsoft Excel

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 objectivesReviews Assessments for training and quality assurance purposesWorks closely with the Senior Management to identify and review downgrades for potential assessment errors, as well as identify and review potential rating category upgradesAnalyzes 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 requiredBachelor's degree in Nursing preferredTwo (2) years of experience completing MDS assessments requiredTwo (2) years with electronic medical records requiredPrior supervisory experience preferredexperience developing documentation of processes preferredCompetencies, Knowledge and Skills:Strong knowledge of UCA assessment toolStrong oral and written communication skillsExcellent analytical and organizational skillsEffective teaching skillsExcellent technology skills, including use of electronic health records and Microsoft ExcelAble to function effectively as part of a teamAbility to translate complex concepts into understandable guidelines preferredLicensure and Certification:Current Registered Nurse (RN) license in Massachusetts in good standing requiredWorking Conditions:General office environment; may be required to sit or stand for extended periods of timeTravel is not typically requiredCompensation Range:$72,200.00 - $115,500.00CareSource 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.Compensation Type (hourly/salary):SalaryOrganization Level CompetenciesFostering a Collaborative Workplace CultureCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the BusinessThis 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.#LI-JS2Brand=Commonwealth Care Alliance