Registered Nurse Manager for Personal Care Management Evaluation Department

About the role

The Program Manager for the PCM Evaluation Department is a Registered Nurse who oversees Evaluation services for people with disabilities applying to or reapplying to the MassHealth Personal Care Attendant Program. This position ensures quality assurance, process improvement, project and report management for the PCA Program, and provides training related to regulation or process changes.

Responsibilities

• Assure high-quality supports by providing direction and supervision in all aspects of the PCA Evaluation process.
• Organize staff and staffing functions to provide appropriate, efficient, and quality PCA evaluation services.
• Monitor scheduling of staff to ensure economy and efficiency of consumer contact and Evaluation Department coverage.
• Monitor and improve job performance of all Evaluation Department staff; offer constructive feedback and conduct timely performance evaluations.
• Collaborate with the IT department to ensure appropriate technical solutions and improvements for Evaluation Department staff.
• Educate consumers and healthcare providers on PCA Program regulations.
• Provide insight, support, and education to colleagues regarding Evaluation Department functions.
• Oversee the complaint policy for PCA consumers or surrogates.
• Manage administrative processes in consultation with Human Resources, Information Technology, and Compliance departments.
• Ensure quality assurance of the PCA Program performance; provide feedback and suggestions for improvement to the Director of Community Services.
• Design metrics to track the quality of PCA Program performance according to contract and Evaluation Department services.
• Review time worked and calendars for biweekly payroll verification; review and approve/deny vacation requests.
• Attend monthly staff meetings, management meetings, case conferences, and other relevant meetings or trainings.
• Provide ongoing staff training as PCA program processes are improved or updated.
• Periodically observe staff in the community and offer feedback.
• Provide daily support and feedback to Evaluation Department staff.
• Initiate Critical Incident reports as appropriate.
• Communicate with consumers regarding questions related to MassHealth Evaluation.
• Complete MassHealth Evaluations for the PCA Program, including re-evaluations or adjustments as needed.
• Provide coaching to staff and document efforts as needed.
• Review tracking reports to monitor timelines, monthly reviews of evaluations completed by each staff (including number completed, error rate, and MassHealth inquiries).
• Follow up with staff regarding timeliness of adjustments and re-evaluations.
• Oversee initial and re-evaluation assignments.
• Review initial evaluations for completeness.
• Review all re-evaluations with reduced hours indicating changes greater than 20% (plus or minus) and follow up as needed.
• Terminate consumers found ineligible at the initial evaluation and ensure documented progress notes in the database.
• Review and appropriately process consumers found ineligible at initial evaluation or re-evaluations/adjustments and document in the database.
• Assist with and follow up on MassHealth inquiries with staff and respond when appropriate.
• Frequently interact with MassHealth to escalate quality-of-care issues and facilitate problem solutions.
• Provide support and updates to RN Consultants.
• Communicate regularly with administrative staff regarding scheduling initial evaluations and follow up on the status of initials, re-evaluations, and administrative projects.
• Provide coverage and support for PCA Program staff in the absence of other PCM Supervisors.
• Participate in MassHealth meetings as needed.

Requirements

• Current RN licensure.
• Prefer at least 5 years' experience doing clinical assessments, PCA Evaluations or Re-evaluations, or working directly in the PCA program.
• Must be computer literate with the ability to use spreadsheets and databases for information management and oversight.
• Prefer previous supervisor experience.
• Outstanding customer service skills.

Work Environment

This job operates in a professional office and home environment. The role routinely uses standard office equipment such as computers, phones, photocopiers, and electronic filing systems.

Physical Demands

The physical demands described are representative of those required to successfully perform the essential functions of this job:

• Regularly required to communicate.
• Frequently required to sit, stand, walk, use hands to finger, handle, or feel, reach with hands and arms, and carry a laptop computer and/or documents.

Travel

Occasional travel is required for this position. Must have a valid driver's license and reliable transportation.

Schedule

• In-person for 3 weeks of training in the Stoughton, MA office.
• Hybrid schedule after training: 2 days in the office.
• Core hours: 8:30 AM to 4:30 PM, Monday through Friday.

Pay

$75,000 - $85,000 salary range.