Team Lead, UCA Reviewer

CareSource; Oklahoma City (OK); Sur place; USD 72 000 - 116 000; Plein temps

Avantages offerts par ce poste

Bonus tied to performance

Résumé du poste

CareSource is seeking a Team Lead, Assessment Review & Submission to supervise a team of RN Reviewers responsible for quality assessments and timely submissions. The role requires RN licensure and experience with MDS processes.

The incumbent will train staff, monitor performance, and collaborate with senior management to optimize workflows and rating accuracy. This position emphasizes compliance and member-focused care.

Qualifications

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

Responsabilités

• Lead and supervise RN Reviewers to ensure timely, compliant assessments and submissions.
• Onboard and train assessment review nurses on SOPs and quality standards.
• Maintain expert knowledge of MA assessment processes and rating categories.
• Balance nurse workload with manager to ensure on-time submissions and quality.
• Review assessment visits to develop best practices and improve patient experience.
• Collaborate to improve workflow and achieve team objectives.
• Identify potential downgrades or upgrades and review rating categories as needed.
• Analyze claims, medical records, and data to flag misclassified members and request status changes.

Connaissances

UCA assessment tool

Oral and written communication

Analytical skills

Organizational skills

Teaching skills

Microsoft Excel

Team collaboration

Communication of complex concepts

Formation

Associate degree in Nursing

Bachelor's degree in Nursing

Outils

Electronic Health Records (EMR)

Description du poste

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.

Compensation Range

$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.

Compensation Type (hourly/salary): Salary

Organization Level Competencies

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

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.