RN Utilization Review Home Health Full-time
SSM Health

Mgr-RN Quality Review and Coding, Continuum of Care

SSM Health Midtown, OK 73103, US
$82,867.20 - $132,579.20 / year

It's more than a career, it's a calling

IL-REMOTE

Worker Type:

Regular

Job Highlights:

We are looking for nurse who possesses leadership and oversight of documentation quality processes for home health and hospice services. This role ensures consistent, high-quality clinical documentation and works collaboratively across teams to maintain compliance and support billing integrity.

In this role you will be responsible for

  • Oversee quality review of clinical documentation processes across home health and hospice
  • Monitor front-end documentation workflows to ensure consistency, accuracy, and adherence to standards
  • Lead and manage the coding team responsible for evaluating documentation for coding accuracy and billing integrity
  • Partner with cross-functional stakeholders to identify risks and recommend process improvements impacting documentation and billing
  • Support compliance initiatives and uphold organizational standards for documentation quality and integrity

Qualifications

  • Experience in clinical documentation quality review, coding, or related healthcare operations
  • Strong understanding of documentation standards, coding practices, and billing integrity
  • Demonstrated ability to lead teams and manage performance in a complex healthcare environment
  • Experience collaborating across departments to drive process improvement and risk mitigation
  • Knowledge of home health and/or hospice operations

Pay Range:

$82,867.20 - $132,579.20

Pay Rate Type:

Salary

SSM Health values the skills and talents that each team member brings to our organization. Compensation for this role is based on a variety of components including relevant experience, labor market, and other qualifications. The posted pay range for this position is what SSM Health reasonably expects, in good faith, to offer based on the circumstances at the time of posting. SSM Health may ultimately pay more or less than the posted range as permitted by law.

Job Summary:

Provides oversight and leadership of the daily operations of the quality review and coding team.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

  • Identifies areas for process improvement and participates in the development, implementation, evaluation and monitoring of new processes for quality review and coding. Leads others during implementation of changes. 
  • Coordinates and communicates key issues, status, or other information with regional operational and system leaders. 
  • Collaborates with providers to promote quality outcomes for operations. Supports operations by problem identification and resolution, cost containment, implementation of new services, and systems/performance measures. Uses evidence-based research and best practice for improvement of patient care outcomes and clinician efficiency. 
  • Supports the review of Outcome and Assessment Information Set (OASIS) assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy. Utilizes OASIS variation or alert report when reviewing OASIS data and ensures applicable OASIS files are uploaded and shared to Center for Medicare and Medicaid Services (CMS) portal. 
  • Notifies organizational leadership of opportunities resulting from the OASIS reviews. 
  • Serves as subject matter expert for evaluation, management, procedural quality review and coding in assigned areas. Interacts with quality reviewers, coders, physicians, and other health care practitioners to ensure common understanding of coding and documentation, guidelines/principles, government and commercial payer rules and regulations. 
  • Acts as a resource to physicians, information technology, and quality review and coding teams regarding electronic health record templates and tools. Assists with template development and ongoing review to ensure templates facilitate streamlined workflow for physicians while also ensuring accurate code selection. Provides support to physicians as requested or deemed necessary, may be required to travel to provider.  
  • Provides oversight to ensure coders can abstract code and work charge/claim review, queues, and coding-related denials. 
  • Recruits, engages, develops, leads, and manages assigned staff.  
  • Performs other duties as assigned.

EDUCATION

  • Bachelor’s degree in nursing required or equivalent years of experience and education 

EXPERIENCE

  • Five years' experience in home health, hospice, post-acute, or other health related organization, with demonstrated leadership responsibility

PHYSICAL REQUIREMENTS

  • Constant use of speech to share information through oral communication.
  • Constant standing and walking.
  • Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
  • Frequent sitting, reaching and keyboard use/data entry.
  • Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
  • Frequent use of smell to detect/recognize odors.
  • Frequent use of hearing to receive oral communication, distinguish body sounds and/or hear alarms, malfunctioning machinery, etc.
  • Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
  • Occasional lifting/moving of patients.
  • Occasional bending, stooping, kneeling, squatting, twisting, gripping and repetitive foot/leg and hand/arm movements.
  • Occasional driving.
  • Rare crawling and running.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS 

 

State of Work Location: Illinois

  •    Driving Record - Motor Vehicle Report (MVR)
  •    And
  •    Driver License – State Issued
  •    And
  •    Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)

    

State of Work Location: Missouri

  •    Driving Record - Motor Vehicle Report (MVR)
  •    And
  •    Driver License – State Issued
  •    And
  •       Registered Nurse (RN) Issued by Compact State 
  •       Or
  •       Registered Nurse (RN) - Missouri Division of Professional Registration

    

State of Work Location: Oklahoma

  •    Driving Record - Motor Vehicle Report (MVR)
  •    And
  •    Driver License – State Issued
  •    And
  •       Registered Nurse (RN) Issued by Compact State 
  •       Or
  •       Registered Nurse (RN) - Oklahoma Board of Nursing (OBN)

    

State of Work Location: Wisconsin

  •    Driving Record - Motor Vehicle Report (MVR)
  •    And
  •    Driver License – State Issued
  •    And
  •       Registered Nurse (RN) Issued by Compact State 
  •       Or
  •       Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services

Work Shift:

Day Shift (United States of America)

Job Type:

Employee

Department:

8444000114 Hospice-HH Coding

Scheduled Weekly Hours:

40

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

  • Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). 
  • Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
  • Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. 

Explore All Benefits

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.

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If the applicant has an out of state license with eNLC, s/he cannot be in a position that bills. * Must possess a strong commitment to patient well-being and safety * Must believe that recovery is possible! Special Requirements: Upon a conditional offer of employment, Department of Mental Health and Substance Abuse Services applicants must submit to a physical examination and shall meet the physical examination requirements of occasionally lifting/carrying 50 pounds and able to push and pull a maximum force of 25 pounds. Applicants must be willing and able to fulfill any job-related travel normally associated with this position and as such have a valid driver’s license. Why Join Us? Generous Benefits: Annual base salary range of $70,000 - $76,500 plus a generous benefits allowance . Comprehensive Health Coverage: A wide choice of health insurance plans with no pre-existing condition exclusions. Flexible Spending Accounts: Options for healthcare and dependent care expenses. Ample Time Off: 11 paid holidays, 15 days of vacation, and 15 days of sick leave in the first year. Retirement Savings Plan: With a generous company match to help secure your future. Employee Assistance Program: Support when you need it. Longevity Bonuses: For years of dedicated service. Training Opportunities: Continuous learning and development for CEU requirements. About us: Griffin Memorial Hospital (GMH) is located in Norman, Oklahoma, and serves all 77 counties in Oklahoma as a Department of Mental Health and Substance Abuse Services (ODMHSAS) treatment center for adults. Griffin Memorial Hospital is a 120-bed acute psychiatric hospital serving persons aged 18 and over with severe mental illness and provides in-patient hospital care for those in need of mental health & substance abuse services. Drug and Alcohol Pre-employment and Preplacement Testing: Upon a conditional offer of employment, applicants for safety sensitive positions shall be required to submit to urinalysis to test for drugs. Appointment to a safety sensitive position shall be contingent upon a negative drug test result. THIS AGENCY REQUIRES COVERAGE 24 HOURS, 7 DAYS PER WEEK. WORK HOURS AND LOCATION MAY VARY DEPENDING ON BUSINESS NECESSITY. EMPLOYEES MAY BE REQUIRED TO WORK WEEKENDS AND OVERTIME. Reasonable accommodation to individuals with disabilities may be provided upon request. An Equal Opportunity Employer. Equal Opportunity Employment The State of Oklahoma is an equal opportunity employer and does not discriminate on the basis of genetic information, race, religion, color, sex, age, national origin, or disability. Current active State of Oklahoma employees must apply for open positions internally through the Workday Jobs Hub . If you are needing any extra assistance or have any questions relating to a job you have applied for, please click the link below and find the agency for which you applied for additional information: Agency Contact