Clinical Nurse Manager
- 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.
- RN Licensed to practice in Massachusetts.
- Graduate of a School of Nursing or College with an accredited RN Program.
- 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.
- 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.
- Flexible schedule
- Paid time off
- Geriatrics
- Home Health
- Medical-Surgical
- Wound Care
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