Registered Nurse

The RN (registered nurse) supervisor Description:

Initial Assessment and Development of the Plan of Care

In addition to ongoing supervision, the RN supervisor is responsible for the clinical assessment and development of the documentation necessary to initiate personal care services. These responsibilities include:

• Research and review the member's available medical records and supporting documentation to determine the member's medical needs, functional limitations, diagnoses, and need for medically necessary personal care services.
• Complete the nursing assessment necessary to determine the appropriate personal care services and level of care required.
• Review the member's medical history, physician documentation, diagnoses, mobility limitations, activities of daily living (ADLs), durable medical equipment, safety concerns, and other relevant clinical information.
• Complete the 485 Plan of Care based on the member's assessed needs and authorized services.
• Complete the Personal Care Screening Tool (PCST) as required.
• Develop and complete any necessary client addendum or supporting documentation required for the member's care.
• Ensure all required clinical documentation is complete, accurate, and consistent with the member's assessed needs and authorized services.
• Fax or otherwise submit the completed 485, PCST, addendum, and other required documentation to the member's physician/PCP for review and signature.
• Follow up with the physician/PCP as necessary to obtain required signatures, orders, and supporting documentation.
• Ensure the documentation supports the medically necessary personal care services being requested and provided.
• Coordinate the authorization and establishment of services prior to the member's start of care.

Start-of-Care Responsibilities

The RN supervisor is responsible for overseeing the member's start of care and ensuring that the member, PCW, and agency are prepared to begin services safely and in accordance with the Plan of Care.

At the start of care, the RN supervisor is responsible for:

• Conducting the start-of-care visit and confirming that the member's services are ready to begin.
• Reviewing the member's Plan of Care, 485, authorized services, and assigned tasks with the member and PCW.
• Explaining all applicable agency policies and procedures to the member and PCW.
• Reviewing required forms and obtaining all necessary signatures and acknowledgments.
• Reviewing payroll and timekeeping requirements with the member and PCW, including proper documentation of hours worked and required clock-in/clock-out procedures.
• Reviewing EVV requirements when applicable.
• Explaining the agency's expectations regarding documentation, attendance, communication, scheduling, and service delivery.
• Reviewing the member's rights, preferences, and service arrangements.
• Confirming that the PCW understands the specific duties and responsibilities associated with the member's care.

PCW Training and Service-Specific Instruction

The RN supervisor is responsible for ensuring that the PCW is appropriately trained to safely perform the personal care services identified on the 485, Plan of Care, or other authorized service documentation.

This includes:

• Providing or coordinating training specific to the member's assessed needs.
• Demonstrating the proper performance of assigned personal care tasks.
• Ensuring the PCW understands the member's specific care needs, limitations, preferences, and safety concerns.
• Reviewing proper procedures for assisting with ADLs and other authorized personal care tasks.
• Verifying that the PCW demonstrates an appropriate understanding of the assigned duties.
• Providing additional instruction or retraining when the member's condition, Plan of Care, or service needs change.
• Documenting training provided and maintaining appropriate records of the PCW's competency and training.

The RN supervisor must ensure that the PCW does not perform tasks outside of the services authorized and identified in the member's Plan of Care.

Ongoing RN Supervisory Responsibilities

Once services have been established, the RN supervisor remains responsible for ongoing clinical oversight and compliance with applicable Wisconsin Department of Health Services requirements.

The RN supervisor is responsible for:

• Conducting the required RN supervisory evaluation of the PCW and member at least every 60 days, or within the applicable required timeframe.
• Reviewing the member's condition and determining whether the current Plan of Care remains appropriate.
• Reviewing the PCW's performance and documentation.
• Evaluating whether authorized services are being provided appropriately.
• Identifying changes in the member's condition that may require a change to the Plan of Care or authorization.
• Communicating necessary changes with the member's PCP/physician and other appropriate parties.
• Updating the Plan of Care and related documentation when changes are identified.
• Providing ongoing direction, education, and training to the PCW as necessary.
• Ensuring that the PCW continues to perform services according to the Plan of Care and applicable agency policies.
• Addressing deficiencies in service delivery and implementing corrective action or retraining when necessary.
• Maintaining complete and accurate clinical and supervisory documentation.

MCO Denials, Peer-to-Peer Reviews, and Appeals

The RN supervisor is also responsible for providing clinical support when a member's personal care services are denied, reduced, or otherwise challenged by an MCO or other payer.

These responsibilities include:

• Reviewing MCO denials, reductions, and authorization decisions.
• Reviewing the member's medical records, Plan of Care, PCST, 485, physician orders, and other supporting documentation.
• Identifying clinical information supporting the medical necessity of the requested services.
• Participating in peer-to-peer evaluations and discussions with the MCO or reviewing clinician when requested or appropriate.
• Providing clinical explanation and justification for the services being requested.
• Preparing or contributing to documentation necessary for an appeal.
• Supporting appeals by providing relevant clinical information, functional limitations, ADL needs, safety concerns, and other documentation demonstrating medical necessity.
• Communicating with the physician/PCP and other involved parties as necessary to obtain additional documentation or clarification.
• Ensuring that appeal and peer-to-peer documentation accurately reflects the member's current condition and care needs.

DHS Regulatory Compliance

The RN supervisor is responsible for ensuring that personal care services are delivered and documented in compliance with applicable Wisconsin Department of Health Services requirements, including applicable provisions of Wis. Admin. Code Chapters DHS 105, DHS 106, and DHS 107, as well as other applicable state and Medicaid requirements.

The RN supervisor is responsible for:

• Maintaining compliance with applicable RN supervisory requirements.
• Ensuring required supervisory visits and evaluations are completed within the required timeframe.
• Ensuring the Plan of Care accurately reflects the member's current needs and authorized services.
• Ensuring services provided by the PCW remain consistent with the authorized Plan of Care.
• Maintaining required clinical, supervisory, and service documentation.
• Ensuring required physician/PCP orders and signatures are obtained and maintained.
• Monitoring changes in the member's condition and initiating appropriate action when changes occur.
• Ensuring the PCW receives appropriate training and supervision.
• Identifying and addressing deficiencies in service delivery or documentation.
• Cooperating with audits, reviews, quality assurance activities, MCO requests, and DHS requirements.
• Maintaining documentation necessary to demonstrate compliance with applicable state and federal Medicaid requirements.

BENEFITS

• 401K
• Health Insurance
• PTO
• Mileage Reimbursement