Clinical Consulting Manager

Responsibilities

• Perform documentation review on medical records to identify clinical elements for accuracy
• Perform post-acute home health and or hospice documentation review on medical records to identify clinical elements for accuracy
• Research and provide comments and recommendations on complex or newly issues home health and or hospice billing regulations
• Review client information systems for complete and accurate clinical documentation
• Research and provide comments and recommendations on complex or newly issued billing regulations
• Conduct weekly calls with the client to present findings and results of the engagement
• Analyze trends and provide process improvement recommendations for clinical operational processes to improve quality of care and patient outcomes
• Review documentation associated with focused medical reviews and write appeals for denied services; provide denial support at the Administrative Law Judge (ALJ) level of appeals
• Participate in cross-team clinical consulting work

Requirements

• Required
• Associate's Degree in nursing, social work, physical therapy or another related discipline
• Active and unrestricted license in related field
• At least 5 years of progressive post acute clinical management experience in home health and /or hospice
• Experience with case management in home health and/or hospice with progressive involvement in Quality Assurance activities
• In-depth knowledge of condition of participations and conditions of payment; extensive knowledge of regulatory standardized assessment documents and patient care protocols
• Proficient in Microsoft Office Suite including Excel, PowerPoint, and Word
• Excellent written and verbal communication and presentation skills are required
• Preferred
• Bachelor of Science in nursing (BSN), social work (MSW), physical therapy or another related discipline
• Experience with Medicare contractor audits and appeals
• Expectations
• Comfortable with remote work arrangements and virtual collaboration tools
• Physical demands include extended periods of sitting, computer use, and telephone communication
• Position at times may include extended or irregular hours outside of traditional office hours to support clients and projects across multiple time zones
• Travel up to 25% as needed

Benefits

Additional Information

About Netsmart At Netsmart, improving care delivery isn't just our aspiration; it's our passion! For more than 50 years, we've been a healthcare software company developing technology and providing services in behavioral health, human services, and post-acute markets. We collaborate with organizations and partner with our clients across the care spectrum to anticipate challenges, identify obstacles, and recognize new opportunities as healthcare evolves. We continuously strive to advance our Netsmart technologies and offerings beyond the EHR by embracing new technology trends that empower healthcare professionals to provide the best possible care. Position Overview: We are seeking a Clinical Consulting Manager with a strong background in Home Health and/or Hospice care to support clinical excellence, quality outcomes, and best practices across post-acute settings. This role is ideal for experienced clinicians who are passionate about care in the home, end-of-life support, interdisciplinary collaboration, and patient-centered care delivery. As a Clinical Consulting Manager, you will partner with clinical teams and organizational leaders to provide guidance, education, and operational support that strengthens care delivery, ensures regulatory compliance, and enhances the patient and family experience across home health and hospice services.

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