RN Clinical Manager Home Health

Become a part of our caring community and help us put health first.

Work Schedule: Full-time/40 Hours

Position Type: Hybrid

Branch Location: Liverpool, NY

The RN Clinical Manager coordinates and oversees all direct care patient services provided by clinical personnel. This role is focused on both home health clinical quality assurance and home health clinical operations initiatives.

• Develops, plans, implements, analyses, and organises clinical operations for a specific location managed.
• Conducts/delegates the assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies.
• Manages the assignment of caregivers.
• Responsible for and oversees the delivery of care to all patients served by the location.
• Receives case referrals and reviews available patient information related to the case, including disciplines required, to determine home health or hospice needs.
• Accountable to ensure patients meet admission criteria and make the decision to admit patients to service.
• Assigns appropriate clinicians to a case, as needed.
• Instructs and guides clinicians to promote more effective performance and delivery of quality home care services.
• Assists clinicians in establishing immediate and long-term therapeutic goals, in setting priorities, and in developing patient Plan of Care (POC).
• Monitors cases to ensure documentation is in compliance with regulatory agencies and requirements of third-party payers.
• Ensures final audits/billing are completed timely and in compliance with Medicare regulations.
• Coordinates communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning.
• Works in conjunction with the Branch Director and Company Finance Department to establish location’s revenue and budget goals.
• Participates in sales and marketing initiatives.
• Supervises all clinical employees assigned to a specific location.
• Responsible for the overall direction, coordination, and evaluation of the location.
• Handles necessary employee corrective action and discipline issues fairly and objectively, in consultation with the Human Resources Department and the Executive Director/Director of Operations.
• Participates in the interviewing, hiring, training, and development of direct care clinicians.
• Evaluates their performance relative to job goals and requirements.
• Coaches staff and recommends in-service education programs, when needed.
• Ensures adherence to internal policies and standards.
• Assesses staff education needs based on own review of clinical documentation in addition to feedback and recommendations by Utilization Review staff.
• Upon completion of the assessment, creates and conducts regular staff education as needed.
• Analyzes situations, identifies problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles.
• Responsible for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, for appropriateness of care, delivery, and documentation requirements.
• Responsible for the QA/PI activities.
• Works with Utilization Review staff relative to data tracking for performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process.
• Competently performs patient care assignments and staff management activities.
• Provides direct patient care on an infrequent basis and only in times of emergency.
• Acts as Branch Director in his/her absence.
• Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical documentation meets internal standards.
• Participates in performance improvement activities, maintains ongoing clinical knowledge through internal and external training programs.
• Provides interpretation of knowledge and direction to staff.
• Maintains relationships with referral/community sources.
• Participates in professional organisations and conducts care-related programs.
• Performs other related duties as assigned or requested.

Required Experience/Skills:

• Graduate of an accredited School of Nursing. BSN required, NY state requirement.
• Current state license as a Registered Nurse.
• Proof of current CPR.
• Valid driver’s license, auto insurance and reliable transportation.
• Two years as a Registered Nurse with at least one year of management experience in a home health environment.
• Home health experience is required.
• Management and people leadership experience, preferred.
• OASIS experience, required.
• OASIS certification (HCS-O, COQS, and/or COS-C), preferred.
• Homecare Homebase (HCHB) experience, preferred.
• CMS PDGM billing knowledge and/or experience, preferred.

Additional Information:

• Normal Hours of Operation: M-F / 8a-5p (ET)
• On-Call Expectation: As needed
• Branch Size: 900 Census (4.5 STAR rating)
• Annual Bonus Eligible: Yes, eligible for the annual incentive bonus which has pay-outs both quarterly and annually.

Scheduled Weekly Hours: 40

Pay Range: $77,200 - $106,200 per year

Description Of Benefits:

Humana, Inc. and its affiliated subsidiaries offer competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us:

CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.

CenterWell creates experiences that put patients at the centre. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc., CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career.

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, colour, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.