Clinical Review Manager

Summary

The Clinical Review Manager (CRM) is responsible forthe clinical review, approval, and oversight of Plans of Care, OASIS documentation, physician orders, add-on evaluation requests, transfers, recertifications, and discharges. The CRM ensures clinical accuracy, regulatory compliance,appropriate utilization of services, and adherence to Medicare Conditions of Participation and agency standards.

The CRM serves as a clinical resource to field clinicians and leadership by promoting documentation excellence,optimizingpatient outcomes, and supporting the delivery of appropriate home health services.

• Review and approve Plans of Care (POCs), Add-On Evaluation requests, transfers, recertifications, and discharges.
• Review and approve physician orders for clinical appropriateness, completeness, and regulatory compliance.
• Ensure OASIS assessments accurately reflect patient condition, functional status, and homebound eligibility.
• Verify documentation supports skilledneed, visitutilization, and reimbursement requirements.
• Ensure care plans are individualized, clinically appropriate, and aligned with physician orders.

• Monitordocumentationquality and regulatory compliance with Medicare Conditions of Participation, state regulations, and agency policies.
• Identify trends related to OASIS accuracy, documentation deficiencies, andutilizationconcerns.
• Collaborate with leadership to implement corrective actions and education plans.
• Participate in QAPI activities, audits, and chart reviews.
• Support survey readiness initiatives and compliance programs.

• Serve as a subject matter expertregardingOASIS, documentation standards, regulations, and care planning.
• Provide coaching and feedback to cliniciansregardingdocumentation quality and accuracy.
• Support onboarding and ongoing education related to clinical documentation.
• Collaborate with Clinical Field Managers to address clinician performance. opportunities.

• Collaborate with physicians, field clinicians, Clinical Field Managers, and agency leadership to ensure appropriate patient care delivery.
• Assist with resolution of clinical documentation issuesimpactingpatient care or reimbursement.
• Escalate significant compliance, quality, or patient safety concerns to leadership.
• Other duties as reasonably assigned.

• Current unrestricted RN license in the state of practice.
• Minimum three (3) years of home health experience preferred.
• Strong knowledge of OASIS, Medicare Conditions of Participation, and home health reimbursement.
• Experience with clinical documentation review, coding, quality improvement, or leadership preferred.
• Excellent analytical, organizational, and communication skills.
• Proficiency with electronic medical records and home health software.

Live Well provides equal employment opportunities (EEO) to all team members and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, or genetics. In addition to federal law requirements, Live Well complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Live Well expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of Live Well team members to perform their job duties may result in discipline, up to and including discharge.

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