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.

• 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.

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 Details

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