• Prospectively review all OASIS assessments to ensure appropriateness, completeness, and regulatory compliance. • Evaluate OASIS data for internal consistency, accuracy, and alignment with patient condition and care delivery. • Utilize OASIS variation, validation, or alert reports to identify potential data integrity concerns. • Ensure documentation supports accurate clinical representation and compliant reimbursement. • Partner with clinicians and agency staff to clarify documentation discrepancies or data integrity issues. • Provide guidance to clinicians on appropriate corrections in accordance with agency policy and regulatory standards. • Support education and reinforcement of best practices related to OASIS completion and assessment accuracy. • Review visit utilization for alignment with patient condition, plan of care, and clinical guidelines. • Identify and report potential underutilization, overutilization, or financial risk to the Coding and OASIS Manager, Clinical Manager, or designee. • Escalate trends that may impact reimbursement, outcomes, or compliance. • Identify and communicate problematic trends or recurring issues identified through OASIS review. • Participate in Quality Improvement and Corporate Compliance initiatives as assigned. • Assist with additional chart audits or documentation reviews as needed.

• Supports successful completion and submission of the MDS (Minimum Data Set) to MassHealth • Examines MDS assessments prepared by clinicians to ensure completeness, accuracy and appropriate explanation of functional status and related clinical findings • Provides feedback to Clinical Care Manager to facilitate optimal documentation and, where necessary, rating category assignment • Supports the Proxy MDS Reviewer (LPN) in completing Proxy MDS submissions for members who cannot be reached for assessment • Completes portions of the electronic MDS-HC form based on diagnoses/information gathered from record review • Prepares printed MDS forms for data entry • Conducts routine training sessions for new Care Management staff and relevant Clinical Care Manager to drive high quality, consistent MDS assessments • Conducts reviews in a timely way in accordance with all timeliness and quality standards • Provides clinical care to members via telehealth technologies (video, chat, etc.)

• Analyze datasets, translating raw data into actionable insights that can support business improvement strategies. • Handle data batches, apply labeling techniques, and manipulate data according to project requirements, ensuring high accuracy. • Oversee the quality of training data, identify issues or anomalies, and implement corrective measures to maintain data integrity. • Provide translations and contextual understanding where necessary to ensure data is aligned with language and cultural nuances. • Offer suggestions aimed at improving business processes and outcomes based on your data analysis.

• Review and evaluate application materials using established admissions criteria • Help identify qualified candidates for admission • Receive training on admissions standards, implicit bias, confidentiality, professionalism, ethics, and conflict-of-interest expectations