Team Lead, UCA Reviewer

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 - $Care Source 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. Care Source reserves the right to amend this job description at any time. Care Source is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JS2

Brand=Commonwealth Care Alliance