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