Utilization Review Nurse jobs

KAT Health LLC
d/b/a BrightStar Care of Pullman/Calumet City
11212 S Western Ave, Unit 2
Chicago, IL 60643

Job Description

Position Title:

In-House Compliance & Clinical Review Nurse (Remote – Philippines)

Reports To:

Director of Nursing (USA)

Department:

Clinical Operations / Compliance

Employment Type:

Full-Time (Remote – International)

Organization Overview

KAT Health LLC d/b/a BrightStar Care of Pullman/Calumet City is a licensed Illinois Home Nursing and Home Services Agency providing skilled and non-skilled care across Chicago and surrounding communities. The agency operates under IDPH regulations, Joint Commission standards, Medicaid/MCO guidelines, VA requirements, Workers’ Compensation, and commercial payer compliance standards.

Position Summary

The In-House Compliance & Clinical Review Nurse is a licensed nurse based in the Philippines who supports U.S. clinical operations remotely. This role works directly under the supervision of the Director of Nursing (DON) in Illinois and is responsible for clinical documentation review, regulatory compliance monitoring, field staff performance audits, care plan validation, and quality assurance oversight. This is a compliance-focused and performance-review role and does not involve direct patient care.

Clinical Documentation & Compliance Oversight

• Review all Skilled Nursing (SN), PT, OT, ST, and HHA documentation for accuracy and completeness.
• Ensure visit notes reflect accurate time in/time out and assessment times align within documented visit windows.
• Audit reassessments, supervisory visits, and care plans for regulatory alignment.
• Validate physician orders, POCs, and signed documentation for completeness.
• Ensure documentation meets IDPH Home Nursing & Home Services regulations (Section 245).
• Monitor Joint Commission readiness documentation.
• Review EVV compliance logs.
• Track and escalate missing documentation within 24–48 hours.

Field Staff Performance Review & Evaluation

• Conduct structured chart audits on field nurses and aides weekly.
• Develop quality scorecards for field clinicians.
• Identify documentation deficiencies and training gaps.
• Support 30-day, 60-day, 90-day and annual performance evaluations.
• Review supervisory visit documentation.
• Assist in reviewing incident reports and corrective action plans.
• Track field staff license expirations and credential compliance.

Regulatory & Audit Readiness

• Maintain internal audit tracker.
• Prepare files for IDPH or Joint Commission review.
• Conduct quarterly mock audits.
• Ensure infection control documentation compliance.
• Validate employee health records compliance per Section 245.
• Monitor training completion records.

Quality Assurance & Risk Management

• Identify trends in documentation deficiencies.
• Report risk exposures to DON.
• Assist in developing corrective action plans.
• Ensure billing-supporting documentation is compliant prior to submission.

Communication & Collaboration

• Attend weekly clinical operations meetings.
• Provide weekly compliance summary reports to DON.
• Maintain professional communication with U.S. staff.
• Escalate urgent compliance concerns immediately.

Required Qualifications

• Active Registered Nurse (RN) license in the Philippines.
• Minimum 3–5 years nursing experience.
• Experience in home health or community health preferred.
• Strong understanding of clinical documentation standards.
• High proficiency in English (written and verbal).
• Experience with EMR systems.
• Strong attention to detail.

Preferred Qualifications

• Experience supporting U.S.-based healthcare operations.
• Familiarity with Illinois Medicaid/MCO documentation.
• Knowledge of Joint Commission standards.
• Quality assurance or compliance background.

Key Performance Indicators (KPIs)

• Documentation error rate below 5%.
• 100% visit note review within 48 hours of submission.
• Reduction in payer denials related to documentation.
• 100% compliance in internal audit reviews.
• Timely completion of performance review audits.

Compliance Statement

This role must maintain strict HIPAA compliance at all times. The employee must sign confidentiality and data protection agreements and adhere to all U.S. healthcare privacy laws and internal agency policies.

Pay: Php39,000.00 per month

Work Location: Remote