Clinical Manager

Clinical Manager
TITLE: Clinical Manager

SUPERVISED BY: Administrator

QUALIFICATIONS: As a Clinical Manager you must be a Registered Nurse and have graduated form an accredited school of professional nursing, BSN preferred. Possess a current license in good standing with the Colorado State Board of Nursing per Colorado State Laws. One year of recent experience in community/home health, two years of acute in-patient care, and previous Managery experience preferred. State laws take precedence over Agency basic requirements of the position. Must be able to make independent nursing decisions and demonstrate critical thinking skills. Must have exceptional organizational and documentation skills. Time management and computer skills essential.

SUMMARY: The Clinical Manager assumes responsibility for the management and oversite of all clinical personnel providing patient services and the health care rendered by them as well as nursing orientation, programs, and functions of the Agency.

RESPONSIBILITIES: As a Clinical Manager it is necessary that you comply with the Nurse Practice Act and Standards of Practice in your state, and that you provide and promote the highest quality of health care as well as to fulfill the following responsibilities in an acceptable manner:

1. Maintain a working knowledge of the state and national regulations and client specific protocols and quality standards and insures that these protocols are met. Develop, implement and monitor all Quality Assurance Performance Improvement programs and activities in conjunction with ABC Home Health Care, Inc.'s management team. These activities include but are not limited to OBQM, HHQI, OBQI, Adverse Event Reporting, Casper Data, ADR review, and the agency's Star rating standing and reporting.

2. Conducts QI meetings in accordance to the CMS guidelines to insure compliance with all regulatory agencies and that the agency maintains the highest ethical standards which include but are not limited to: accurate documentation and record keeping of care provided by the agency staff, documentation that medical necessity and all other applicable reimbursement coverage criteria are met in accordance with all regulatory agencies, patient care meets the standards dictated by each profession and regulatory standards.

3. Assistance with compliance by providing education, and expertise in interpreting CMS regulations and standard requirements, (interpretive guidelines, coverage guidelines, Chapter 7 and 10 and Volume 8 skilled and non-skilled) especially those related to performance improvement and patient safety.

4. Develop, implement and monitor the completion of all corrective action plan for deficiencies identified through utilization review, clinical audits, Adverse Event Reports, Medicare/ Medicaid claim denials, client satisfaction surveys, state surveys, and all Quality improvement plans.

5. Review and approve Oasis documents and POC (485/487's) prior to transmission of data to CMS for completeness, appropriateness, accuracy, and review of ICD 10 coding to ensure consistency and compliance with established criteria for all nursing cases. Review and approve SOC, ROC, Tx, D/C documentation and corresponding addendum orders and ensure all orders are signed and returned. Transmit Oasis weekly and validate transmission reports while reviewing and reporting all errors and corrections made to ensure compliance. Reviews orders for completeness, appropriateness, and accuracy prior to them being sent out.

6. Conduct audits and studies based on pre-established criteria, to assess and monitor the quality of care delivered. Communicate findings verbally and in writing as appropriate, through designated channels, in a timely manner.

7. Establish and maintain data bases for tracking and storing data related to the job assignments and performance improvement activities.

8. Conducts field RN visits and case management per RN job description as needed.

9. Assists in the education of clinical field staff to include but not exclusive to: policies and procedures, in-services related to best practice, etc. Participates in educational programs to expand/enhance personal and professional Quality Improvement objectives. Provide information and education on quality and performance improvement process.

10. Participates in activities of the management and health care team including Advisory Board, Quality
    Improvement, Risk Management, Infection Control, orientation, staff meetings, and quality improvement initiatives. Prepare and maintain compliance with regulatory agencies such as CMS, OSHA, and Colorado State Department of Health, etc.

11. Provides direct field management to all clinical staff as directed by the Administrator, performing related personnel activities including but not limited to: recruitment/hiring/retention, staffing, productivity, vacation tracking, orientation, staff education, supervision, evaluation, documentation review, case management.

12. Responsible for making patient and personnel assignments.

13. Responsible for coordinating patient care.

14. Responsible for coordinating refferals.

15. Responsible for assuring patient needs are continuingly being assessed and met.

16. Facilitates the coordination of nursing and therapy services to ensure patients receive a comprehensive Plan of Care and ensure there is continuity of care. Responsible for assuring the development, implementation and updates of the individual plan of care.

17. Responsible for developing and maintaining a sound orientatinion process of all clinical staff.

18. Review all Medicare client charts and files at the local level to assure proper documentation to maximize reimbursement. This review includes verification of appropriate documentation, quality of care provided, visit utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.

19. Conduct Medicare compliance training programs. Develop reference materials to resolve inadequacies.

20. Review orders for completeness, appropriateness, and accuracy prior to them being sent out.

21. Monitor the receipt of denial notices. Assess the validity of these denials and respond with additional information.

22. Responsible for CNA oversight including all personnel activities and CNA supervision by a registered nurse.

23. Participates in the management of expenditures of the nursing department that include: staff productivity, implementation of LPN use by the RN staff, use of supplies/equipment, educational materials, the nursing education budget, etc.

24. Promotes a positive work environment, effective communication, and appropriate conflict resolution for staff, patients, and business associates.

25. Upholds the highest ethical standards which include full compliance with all regulatory statutes and agencies. To include accurate documentation and record keeping that demonstrate medical necessity and other applicable reimbursement coverage criteria. To protect and maintain patients' confidential health care information and report any potential fraud and abuse to the compliance officer.

26. Maintains an accurate Complaint/Grievance Log and ensures that the Agency thoroughly investigates and responds to all complaints and grievances following the Agency policy and all applicable regulatory guidelines.

27. Participates in educational programs to expand/enhance personal and professional objectives.

28. Use the information obtained from the QI review to improve the quality of patient care, the overall quality of the staff and agency performance, agency policies and procedures, and the development of OBQI goals.

29. Participates in the on-call processes to maintain 24 hour nursing and appropriate clinical and administrative coverage of the agency as determined by the Administrator to meet the needs of the agency.

Job Type: Full-time

Pay: Up to $42.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Family leave
• Flexible spending