Clinical Review Manager

Job Description

Job Description

Summary

The Clinical Review Manager (CRM) is responsible for the 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, optimizing patient outcomes, and supporting the delivery of appropriate home health services.

Primary Responsibilities:

Clinical Documentation Review  

• 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 skilled need, visit utilization, and reimbursement requirements. 

• Ensure care plans are individualized, clinically appropriate, and aligned with physician orders. 

Quality and Compliance  

• Monitor documentation quality and regulatory compliance with Medicare Conditions of Participation, state regulations, and agency policies. 

• Identify trends related to OASIS accuracy, documentation deficiencies, and utilization concerns. 

• 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. 

Clinical Resource and Education  

• Serve as a subject matter expert regarding OASIS, documentation standards, regulations, and care planning. 

• Provide coaching and feedback to clinicians regarding documentation quality and accuracy. 

• Support onboarding and ongoing education related to clinical documentation. 

• Collaborate with Clinical Field Managers to address clinician performance. opportunities. 

Care Coordination  

• Collaborate with physicians, field clinicians, Clinical Field Managers, and agency leadership to ensure appropriate patient care delivery. 

• Assist with resolution of clinical documentation issues impacting patient care or reimbursement. 

• Escalate significant compliance, quality, or patient safety concerns to leadership. 

• Other duties as reasonably assigned.

 

Qualifications:

• 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. 

EEO Statement: LiveWell 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, LiveWell 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. LiveWell 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 LiveWell team members to perform their job duties may result in discipline, up to and including discharge.