Patient Care Manager/RN

General Role Description

The Home Health Patient Care Manager/RN is responsible for the supervision and coordination of clinical services and provides and directs provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies.

Primary Responsibilities

• Receives referrals and ensures appropriate clinician and/or therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits.
• Captures and coordinates determination of patient home health benefits, medical necessity, and ongoing insurance approvals.
• Ensures patient needs are continually assessed and care rendered is individualized to patient needs, appropriate and reasonable, meets home health eligibility criteria, and is in accordance to physician orders.
• Manages and documents phone calls and new orders from physicians, clinicians, patients, referral sources, and communicates patient updates/new orders to clinicians.
• Schedules, prepares for, facilitates, and documents case conference/SOC reports and facilitates effective exchange of information across disciplines especially with adverse findings, changes in patient condition, daily and urgent updates, as necessary.
• Assists clinicians in coordinating the transfer and discharge of patients from agency services as indicated by the physician.
• Reviews clinician visit notes weekly to ensure timely, complete, appropriate, and accurate submission of all documentation by field staff.
• Takes necessary action to correct adverse findings and communicates trending to clinical director.
• Reviews, evaluates, and supervises service delivery to ensure appropriateness of care and utilization of services, equipment, and supplies through activities such as random patient visits, medical record reviews and case conferences.
• Enters infections and incidents/occurrences into the online Risk Management Incident Reporting System, as specified by policy.
• Assists in the orientation of new agency personnel and provides direction and leadership to clinical team members in collaboration with the clinical director.
• Provides high quality clinical services within the scope of practice and within infection control standards, in accordance with the plan of care, and in coordination with other members of the health care team.
• Accurately and timely completes the comprehensive assessments (OASIS) including medication reconciliation.
• Makes the initial and/or comprehensive nursing evaluation visit, ensures patients meet home health eligibility and medical necessity guidelines as defined by payer source, accurately determines primary focus of care, develops the plan of care within State specific guidelines with the physician, and submits accurate documentation.
• Directly and/or indirectly supervises care provided by the home health aides and licensed practical vocational nurses, provides instruction as appropriate, and assigns tasks according to State and federal regulations.
• Initiates, develops, implements, and makes necessary revisions to the plan of care in collaboration with the physician and other health care professionals involved in care.
• Communicates relevant information timely and effectively with appropriate agency staff including but not limited to: any patient care issues or needs, visit assignments, dates of scheduled visits, and schedule changes to scheduler, orders and OASIS data sets, coding requests, schedule home visits, to coordinate care with other clinicians.
• Communicates timely and effectively with physicians, patients, and family members to ensure quality care and service excellence.

Required Qualifications

• Current RN licensure in state of Oregon
• Current CPR certification required
• Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation

Preferred Qualifications

• Able to work independently
• Good communication, writing, and organizational skills

Pay and Benefits

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

The salary for this role will range from $89,680 to $134,520 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.