Manager, Clinical Review Services

About Mosai

Mosai is the intelligent care coordination platform that brings together the fragmented pieces of healthcare into a clear connected picture. Like a mosaic our platform unites data people and processes so providers can make better decisions coordinate care in real time and deliver improved outcomes. With Mosai home-based care organizations can thrive in value-based care while giving every patient the right care in the right place at the right time. Learn more at Summary

• Leads the team that performs OASIS assessment review and ICD-10 coding review for Mosais home health clients with direct people leadership over employed OASIS Reviewers and ICD-10 Coders and ownership of the quality standard applied to all review work including work performed by contracted consultants.
• May be client-facing; serves as the escalation point that resolves disputed findings represents review methodology to client leadership and absorbs the client relationship so reviewers can stay focused on production and accuracy.
• Owns the human-in-the-loop standard for Mosais AI-assisted review platform defining and auditing the expectation that licensed clinicians validate platform findings against the source record and serves as the clinical counterpart to product and engineering on platform accuracy.

Job Duties:

• Recruit interview hire and onboard OASIS Reviewers and ICD-10 Coders verifying licensure and required credentials and supervising ramp on live review work to a defined accuracy threshold before independent assignment.
• Conduct one-on-ones deliver performance feedback and reviews manage underperformance through documented improvement plans and coach reviewers on the quality of written recommendations.
• Define document and maintain the review accuracy standard audit methodology and sampling approach; run a recurring quality audit program across employees and contractors with findings trending and documented corrective action.
• Facilitate calibration and inter-reviewer reliability exercises investigate and resolve inconsistent findings between reviewers and maintain the review playbook and client-specific parameter documentation.
• Monitor platform override rates and own the human-in-the-loop policy for AI-assisted review holding the team accountable to independent validation of every platform finding; serve as clinical point of contact to product and engineering aggregating feedback and providing clinical sign-off on platform changes.
• Forecast review volume allocate work across employees and contractors to meet contracted turnaround commitments match assignments to credentials held and escalate capacity shortfalls before they affect client billing.
• Serve as the escalation point for disputed findings explaining clinical rationale and applicable CMS guidance to client clinical leadership and represent review methodology and quality standards in client business reviews and onboarding.
• Maintain a credentialed consultant pool match contract assignments to credentials and client scope audit contractor deliverables against the same accuracy standard applied to employees and coordinate with legal compliance and finance on contractor agreements without directing a consultants hours schedule or method of performing review.
• Oversee client EMR access provisioning and deprovisioning audit access and activity logs ensure required security HIPAA and compliance training is completed before client work begins and escalate suspected privacy incidents or unauthorized access immediately.
• Maintain current expertise in OASIS guidance PDGM CMS Conditions of Participation HH QRP HHVBP and ICD-10-CM coding for home health and own the process for absorbing guidance and code set changes into team standards training and platform logic.

Minimum Requirements

• Active unrestricted Registered Nurse (RN) license required.
• Current COS-C (Certificate for OASIS Specialist Clinical) or HCS-O (Home Care Clinical Specialist OASIS) certification required at hire.
• Minimum of 5 years of clinical experience in Medicare-certified home health required.
• Minimum of 2 years of people leadership experience required including hiring performance management and direct supervision of clinical staff.
• Demonstrated experience in OASIS review clinical QA coding audit or documentation integrity required.
• Hands-on experience with one or more major home health EMR platforms required.
• Deep command of OASIS conventions item intent and time point requirements sufficient to adjudicate disagreements between experienced reviewers and the ability to lead a remote distributed team across multiple clients EMRs and time zones.

Work Environment

• This is a hybrid role based in Jacksonville or Nashville.
• Primarily sedentary work performed in a remote or office setting with extended periods of computer and screen use.
• May be client-facing; serves as the escalation point for disputed findings and represents review methodology to client leadership.
• Remote work requires a secure private workspace and a reliable internet connection meeting Mosai and client security standards.
• Occasional travel for client meetings team meetings or industry conferences.
• Holds full authority over review standards staffing and the quality program but no authority over client clinical records submissions or clinical practice.

Preferred Skills and Experience

• BSN preferred; Associates degree in Nursing with equivalent leadership experience considered. Multi-state licensure or Nurse Licensure Compact participation preferred.
• Current HCS-D (Home Care Coding Specialist Diagnosis) certification strongly preferred given oversight of coding review work and audit of coding deliverables; BCHH-C or COQS considered as equivalents.
• Experience designing or running a clinical quality audit or calibration program strongly preferred; prior experience in an outsourced vendor or multi-client service environment strongly preferred.
• Experience managing or coordinating contract or contingent clinical staff preferred; experience with Homecare Homebase preferred.
• Experience with clinical software decision support or AI-assisted review tools preferred.

Physical Demands of Our Work Environment

This position uses a computer and other office equipment as needed to perform duties. The in-office noise level in the work environment is typical of that of an office. Frequent interruptions may be encountered throughout the workday.

The employee is required to either stand or sit talk and hear frequently required to use repetitive keying or hand motions.

The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Mosai is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion national origin sex sexual orientation gender identity veteran status and disability or other legally protected status If you are unable to submit an application because of a incompatible assistive technology or disability please contact us at . We will make every effort to respond to your request for disability assistance as soon as possible.

Mosai is an E-verify employer. Your eligibility to work in the United States will be verified through the E-verify system if you apply and are selected for a position.

Required Experience:

Manager