Clinical Nurse Manager

Job description

We are currently looking for a Registered Nurse (RN) who will help us with daily operations and serve as a clinical coordinator/manager for our home health agency.

Position Summary

• The RN will function as a Clinical and Admissions Coordinator.
• The nurse will help manage the daily operations of the agency and coordinate patient intake/ admissions.
• Reviews and coordinates all needed clinical information before patient admission to ensure the perfect pathway for new patients.
• Communicate with Nurse manager and teams regarding new patients.

Current RN License required

Qualifications

Educational

RN Licensed to practice in Massachusetts.

Graduate of a School of Nursing or College with an accredited RN Program.

Experience

• Minimum 2 years related experience including home healthcare, medical/surgical, and community health and/or experience with a managed care organization.

Previous intake, liaison or discharge planning experience is preferred.

Knowledge of home health care standards and practices (preferred)

Knowledge of medical terminology and treatment modalities of patient diagnoses required

Knowledge of Medicare, Medicaid and other insurance payers.

Functions & Responsibilities

• Coordinates referrals from hospitals, physicians, other health facilities, community agencies, and patients and their families between patient account center and the clinical nursing team.
• Demonstrates advanced knowledge of home health and Hospice eligibility criteria and COP for purposes of appropriate referral coordination.
• Prepare and maintain on-call schedule and serve as a back up for on-call
• Assist with marketing activities as required.
• Serve as a liaison for branch office when dealing with corporate on; billing, payroll and collection resolution.
• Primary responsibility for all training (new hires and existing employees). This includes Staffing Coordinators and Administrative Support Coordinators, specific to their job descriptions.
• Responsible for tracking and reporting all prior approvals for Medicaid and Managed Care contracts and to coordinate all activities with Corporate Billing personnel.
• Responsible for intake of all private pay and insurance cases along with all appropriate paperwork.
• Serve as a liaison between nursing staff, coordinators and corporate regarding client care and payment issues.
• Responsible for coordinating weekly staff meetings with all office staff.
• On a weekly basis review non-compliance reports and remove from cases, all field personnel who are out of compliance with regulatory requirements.
• Participate as required in contract meetings, team meetings and client case conferences.
• Communicates with the patient’s physician, family and others to obtain complete referral information and to assist in organizing resources necessary for patient care prior to admission.
• Triages incoming clinical phone calls from patient’s families and referral sources.
• Collaborates with clinical staff and evaluates patient information/clinical documentation to ensure patient is appropriate for home health care and will be services on the perfect pathway to optimize clinical care.
• Performs thorough clinical assessment of the referral and ensure patient is placed on the perfect pathway and coordinates back with referral source any recommendations.
• Makes preliminary arrangements for any special medical supplies/equipment or for other community services that a patient may require upon admission.
• Communicates with appropriate pod staff to share patient referral information.
• Communicates with pod staff regarding daily capacity. Able to coordinate/communicate that with the patient admissions coordinator.
• Documents and obtains MD orders as appropriate.
• Provides support for Utilization Review and Quality Assurance activities as requested.
• Maintains records and reports of referrals and admissions.
• Provides support for the process of obtaining insurance verification and initial authorization for services.
• Communicate with referral sources, families, and physicians to confirm admission.
• Provides for special customer service referral arrangements with hospitals and physician offices and works closely with liaison staff.
• Participates in the orientation of new staff.
• Assists with liaison functions as necessary.
• Actively participates in activities to attain department goals.
• Participates in ICD-9 coding of referrals.
• Assists in referral entry as needed.
• Upholds the compliance objectives, policies, and procedures of the Foundation and Subsidiaries.
• Performs other related duties of a similar nature and complexity as directed.

Job Types: Full-time, Part-time, PRN, Per diem

Pay: $50.00 - $60.00 per hour

Expected hours: 24 – 40 per week

Benefits

• Flexible schedule
• Paid time off

Medical Specialty

• Geriatrics
• Home Health
• Medical-Surgical
• Wound Care

Work Location: In person