Clinical Review Manager, Hospice Home Care
 VNS Health | |
paid time off, tuition reimbursement
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 United States, New York, New York | |
| 220 East 42nd Street (Show on map) | |
 Dec 18, 2024 | |
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OverviewThe Hospice Clinical Review Manager's primary responsibility is ensuring compliance with local coverage determinants (LCD) in coding and documentation upon Start of Care (SOC) and recertification for hospice patients. The main objective of the role is enhancing the quality of care through effective clinical record review. They are responsible for Hospice Item Set (HIS) review for accuracy, for managing and analyzing the plan of care and ensuring it is in alignment with assessments documented. They review and ensure criteria for coverage is clearly documented and Plan of Care's are coded appropriately for hospice care. This role involves ensuring compliance with regulatory standards related to comprehensive assessment and LCD criteria. They act as a resource to the clinical team and support clinical team members by providing feedback related to LCD, HIS and hospice documentation to support hospice care. This role is responsible for oversight of the Certification for Terminal Illness (CTI) orders clinical management in the EHR, when generating the Plan of Care Order for hospice. The Hospice Clinical Review Manager is an integral part of the QAPI team and assists in clinical record reviews to assess for quality of care and identify areas of opportunity. What We Provide
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