The Clinical Quality Program Manager ensures organizational compliance with state and federal regulations while driving quality improvement initiatives across post-acute care settings. They are responsible for analyzing performance data, conducting audits, and leading committee meetings to maintain NCQA and CMS accreditation standards.
The Clinical Reviewer manages medical necessity denials from initial notification through final resolution by applying clinical guidelines and payer requirements. They collaborate with physicians and healthcare providers to ensure appropriate levels of care and develop evidence-based appeals.
Design and build complex, scalable software features across varied architectures, collaborating with product and design partners to turn requirements into technical solutions. Improve system performance and code quality through bottleneck analysis, technical documentation, code reviews, rigorous testing, and the use of AI development tools.
The Clinical Consultant II leads the implementation of WellSky solutions by bridging the gap between clinical workflows and software functionality. They are responsible for gathering requirements, providing hands-on training, and ensuring clinical solutions comply with industry regulations.
Conduct telephonic patient assessments to determine appropriate levels of care and participate in program planning to develop clinical protocols. Collaborate with stakeholders to manage patient follow-up plans and report on program outcomes and key performance indicators.
The Sleep Coach conducts outbound calls to patients to facilitate CPAP supply reorders and promote equipment sales. They are responsible for maintaining patient records, ensuring compliance, and providing high-quality customer service.
Lead the strategy, design, and implementation of post-acute clinical programs, and provide expert medical reviews and operational guidance across emergency department, acute, and post-acute care services. Support care transitions, document review outcomes in accordance with regulatory and accreditation requirements, and collaborate with clinical teams, clients, and stakeholders to improve quality and effectiveness.
Lead the design and implementation of large-scale, complex software systems while fostering a culture of continuous improvement and technical excellence. Collaborate with cross-functional teams to define requirements and drive the adoption of best practices, including AI-enhanced workflows and CI/CD processes.
The Medical Coder is responsible for accurately assigning ICD-10-CM and OASIS codes supported by clinical documentation. They must ensure compliance with coding regulations and internal policies to facilitate accurate billing for client agencies.
Serve as a trusted partner for clients by providing medical coding training and addressing related issues. Collaborate with internal teams to optimize the coding experience and conduct clinical record audits for compliance.
