Cliniqon LLC
We are seeking a detail-oriented and experienced Registered Nurse (RN) Home Health Utilization Reviewer to join our growing team. This role is ideal for a nursing professional with strong home health knowledge, excellent clinical judgment, and experience managing utilization, documentation quality, and regulatory compliance. As a Home Health Utilization Reviewer , you will play a vital role in ensuring appropriate patient care delivery, supporting clinicians, improving documentation accuracy, and optimizing home health operations. You will collaborate with clinical teams to identify utilization risks, strengthen compliance, and help achieve quality outcomes for our patients. We are looking for someone who is available to start ASAP. Key Responsibilities Prepare and submit daily utilization review reports, including completed reviews, pending charts, productivity, turnaround times, and workload status Track and report LUPA (Low Utilization Payment Adjustment) risk cases , identify patients at risk, and communicate recommendations to the clinical team to support appropriate visit utilization Monitor and report utilization metrics, including visit frequency adherence, episode utilization, authorization utilization (when applicable), and other key operational indicators Identify and escalate high-risk cases, compliance concerns, overdue documentation, physician signature delays, and other issues that may impact patient care, reimbursement, or regulatory compliance Track utilization metrics, denials, and authorization trends to improve quality outcomes and reduce unnecessary costs Follow up with clinicians regarding ordered visit frequencies to ensure visits are completed as scheduled Monitor visit utilization throughout the certification period, identify missed or delayed visits, and verify whether visit frequencies remain appropriate based on the patient’s current condition Utilize WellSky/Kinnser EMR to review, update, and manage patient records while maintaining documentation accuracy and integrity Collaborate with Clinical Managers, QA teams, Case Managers, and field clinicians to resolve documentation issues and improve overall chart quality Monitor documentation turnaround times and ensure reviews are completed within established productivity and quality benchmarks Maintain accurate, timely, and complete clinical documentation to support quality patient care and appropriate reimbursement Qualifications & Requirements: Must be a Registered Nurse (RN) Home Health experience is required Hands-on experience using WellSky/Kinnser EMR Strong understanding of OASIS documentation, Medicare Home Health regulations, and Plan of Care (POC) review Familiarity with LUPA (Low Utilization Payment Adjustment) and home health utilization management Experience preparing and presenting daily utilization reports, productivity reports, LUPA risk reports, and other operational metrics Strong analytical skills with excellent attention to detail Effective communication and collaboration skills with clinicians, Clinical Managers, and interdisciplinary teams Ability to work independently while meeting productivity, quality, and compliance expectations Why Join Us? Permanent work-from-home Retention bonus Performance bonus Immense growth opportunities Company-provided assets HMO coverage Many more benefits Apply today and become an essential part of our mission to deliver exceptional home health care! Send your resume to: aalvior@cliniqon.com Benefits Health insurance Life insurance Opportunities for promotion Paid training Pay raise Promotion to permanent employee Work from home Application Question(s): Are you a licensed Registered Nurse (RN) with an active nursing license? Do you have previous Home Health experience? Do you have hands-on experience using WellSky/Kinnser EMR for reviewing and managing patient records? Do you have experience with OASIS documentation, Medicare Home Health regulations, and Plan of Care (POC) review? Are you available to start ASAP? Work Location: Remote
Cliniqon LLC
