Care Manager, RN – PEDS
Centene Corporation
RN Clinical Manager
CenterWell Senior Primary Care
full-time
Posted on:
Location: Tennessee • 🇺🇸 United States
Visit company websiteSalary
💰 $77,200 - $106,200 per year
Job Level
JuniorMid-Level
About the role
- The RN Clinical Manager coordinates and oversees all direct care patient services provided by clinical personnel.
- This role focuses on home health clinical quality assurance and home health clinical operations initiatives.
- Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed.
- Conducts/delegates assessment and reassessment of patients, including updating of care plans and interpreting patient needs, while adhering to Company, physician, and/or health facility procedures/policies.
- Manages the assignment of caregivers and oversees the delivery of care to all patients served by the location.
- Receives case referrals and reviews patient information to determine home health or hospice needs.
- Ensures patients meet admission criteria and decides to admit patients to service.
- Assigns appropriate clinicians to a case and guides clinicians to promote more effective performance and delivery of quality home care services, available at all times during operating hours.
- Assists clinicians in establishing immediate and long-term therapeutic goals and in developing patient Plan of Care (POC).
- Monitors cases to ensure documentation is in compliance with regulatory agencies and third-party payer requirements.
- Ensures final audits/billing are completed timely and in compliance with Medicare regulations.
- Coordinates communication among team members/attending physicians/caregivers to ensure appropriateness of care and outcome planning.
- Works with Branch Director and Company Finance to establish location’s revenue and budget goals.
- Participates in sales and marketing initiatives.
- Supervises all clinical employees assigned to a specific location and is responsible for direction, coordination, and evaluation.
- Handles necessary employee corrective action and discipline issues with HR consultation.
- Participates in interviewing, hiring, training, and development of direct care clinicians; evaluates performance; coaches staff; ensures adherence to policies.
- Assesses staff education needs and conducts regular staff education; applies Performance Improvement principles.
- Responsible for QA/PI activities; data tracking for performance review with Utilization Review.
- Performs patient care assignments and staff management; direct patient care infrequently in emergencies.
- Acts as Branch Director in absence; interprets Company standards and policies; ensures compliance with external authorities.
- Participates in performance improvement activities and maintains clinical knowledge through training.
- Maintains relationships with referral/community sources and participates in professional organizations; conducts care-related programs.
- Performs other related duties as assigned.
Requirements
- Graduate of an accredited School of Nursing.
- Current state license as a Registered Nurse.
- Proof of current CPR.
- Valid driver’s license, auto insurance and reliable transportation.
- Two years as a Registered Nurse with at least one-year of management experience in a home care, hospice or equivalent environment.
- Home health experience is preferred .
- Management and people leadership experience, preferred .
- OASIS experience, preferred.
- OASIS certification (HCS-O, COQS, and/or COS-C), preferred .
- Homecare Homebase (HCHB) experience, preferred .
- CMS PDGM billing knowledge and/or experience, preferred .
