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Clinical Central Review Associate
BAYADA Home Health Care. Learn all aspects of clinical management under the guidance of the Clinical Manager / Rehabilitation Manager and the Director .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical management, including oversight of service delivery, accurate ICD coding, and case management. Holds a current nursing license and possesses strong interpersonal skills to effectively coordinate care and support staff development.
Highest-signal resume keywords
Registered Nurse LicenseClinical ManagementICD CodingCase ManagementInterdisciplinary Communication
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical Documentation ReviewEpisodic Utilization MonitoringInfection-Control InvestigationsNursing Skills ChecklistAuthorization Management
Soft Skills
Interpersonal SkillsGoal AchievementClient AdvocacySupervisionCommunication
Tools & Technologies
Medical Supplies CoordinationQuality Improvement ActivitiesContinuing Education Management
Certifications & Qualifications
BSNMaster’s Degree (Preferred)Nursing Program Graduate
Industry Keywords
Medicare Conditions of ParticipationRegulationsProfessional StandardsContinuing Education Units (CEUs)Criminal Background Checks
About the role
Key responsibilities & impact- Learn all aspects of clinical management under the guidance of the Clinical Manager / Rehabilitation Manager and the Director
- Participate in oversight of service delivery to ensure superior quality
- Review clinical documentation for consistent, accurate, high-quality services
- Work with MCM to ensure accurate ICD coding
- Monitor episodic utilization according to care protocols
- Assign appropriate clinicians to clients
- Ensure documentation progresses from start of care to discharge
- Support case management, including HHA and LPN supervision, authorization management, and interdisciplinary communication
- Coordinate medical supplies with MCO and MCM
- Act as internal case manager and client advocate
- Participate in infection-control investigations and improvement planning
- Respond to ADRs and denials
- Assist with hiring, interviewing, orientation, competency observation, supervision, feedback, evaluations, and development of field staff
- Liaise between field and office staff and communicate with Clinical Practice Leadership
- Independently manage a caseload as directed
- Provide clinical guidance to office colleagues and support administrative activities
- Represent BAYADA in community and marketing activities
- Participate in quality/performance improvement activities and office/company meetings
- Transition into the Clinical Manager I role under guidance of a Clinical Manager Mentor
- Answer phones, greet visitors, and generate correspondence as needed
- Maintain knowledge of professional standards, BAYADA policies, procedures, and regulations
- Pursue professional growth through continuing education and/or organizational membership
Requirements
What you’ll need- Holds a current license in good standing as a Registered Nurse, PT, OT, or ST
- BSN / Master’s preferred and required based on state regulations
- Graduate of an accredited and approved nursing program
- Demonstrated record of strong interpersonal skills
- Demonstrated record of goal achievement
- Demonstrated ambition to take on more responsibility and grow past current position
- Passing score on the appropriate nursing quiz and all required competency tests
- Knowledge of the Medicare Conditions of Participation and other program requirements
- Completed Nursing Skills Checklist appropriate to the client population
- Completed criminal background and federal/state program exclusions checks
- Completed continuing education requirements (CEUs) as required by regulation
Benefits
Comp & perks- Bonus Opportunity available
- Paid holidays
- Vacation and sick leave
- Vision, dental and medical health plans
- Employer paid life insurance
- 401k with company match
- Direct deposit
- Employee assistance program