Clinical Nurse Manager
Position Summary
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
Current RN License Required
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
Captures and maintains on-call schedule and serves as a backup for on-call.
Affixes to marketing activities as required.
Serves 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). 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.
Serves 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 reviews non-compliance reports and removes from cases, all field personnel who are out of compliance with regulatory requirements.
Participates 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.
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.
Affixes to liaison functions as necessary.
Actively participates in activities to attain department goals.
Participates in ICD-9 coding of referrals.
Affixes to referral entry as needed.
Upholds the compliance objectives, policies, and procedures of the Foundation and Subsidiaries.