CenterWell Senior Primary Care

Director

• Develops, plans, implements, analyzes and organizes operations for the Branch
• Responsible for the delivery of care for all patients served by the Branch by providing supervision and support to the Clinical Manager(s)
• Works in conjunction with the Area Director of Operations or the AVP of Operations and Finance Department to establish Branch’s revenue and budget goals
• Recognizes the clinical leadership and provides support and supervision to the Clinical Manager(s) to promote more effective performance and delivery of quality home care services
• Maintains office operations in an efficient, productive, effective, and organized manner, which provides a safe working environment for employees, meeting local ordinances and fire and safety regulations in compliance with the company policies
• Conducts continuous quality improvement quarterly committee meetings, reviews all patient satisfaction data, and follows up on negative patient satisfaction surveys and follow-up visits with referral sources
• Communicate with the Area Director of Operations or the AVP of Operations for direction, problem-solving, and implementation of programs and protocols
• Partners with Sales Directors and Account Manager(s) to meet budgeted admission goals
• Participates in sales and marketing initiatives
• Use your skills to make an impact

Branch Director - Home Health

Auditor

• Assesses the compliance risks to PCO and leverages the assessment to design the auditing and monitoring activities included in the workplan
• Executes assigned portions of the PCO compliance workplan throughout the year
• Regularly conducts compliance-related audits to assess internal controls, examining healthcare records and processes, and analyzing and reporting risks
• Influences department strategy by identifying and overseeing the development of continuous monitoring activities
• Provides reporting on metrics and M&A activity related to revenue cycle management
• Coordinates site visits for regulators and implementation of corrective action plans
• Serves as regulatory compliance subject matter expert with the 2nd line of defense
• Researches compliance-related issues and communicates requirements to high-level business leaders within the PCO

Sr Compliance RCM & Coding Auditor

Manager

• The RN Care Manager employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues.\n• Identifies and resolves barriers that hinder effective care.\n• Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations.\n• May create member care plans.\n• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.\n• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.\n• Follows established guidelines/procedures.\n• Use your skills to make an impact.\n• Working within an interdisciplinary care integration team (CIT), the Care Manager – Registered Nurse is responsible for proactively engaging patients and implementing targeted interventions to address whole person health and increased access to care.\n• The Care Manager – Registered Nurse will provide guidance and oversight of care coordination efforts to other members of the team, and manage clinical escalations as indicated.\n• This role requires an understanding of how socio-economic stressors can impact ability to engage in healthcare and subsequent health outcomes.\n• Experience will ideally include prior care or case management work with transitions of care and high-risk patient management programs in partnership with PCP care team members including community health workers, pharmacists, and behavioral health specialists.\n• Conduct Transitions of Care Management for a subset of the patient population, including hospital, obs, and post-acute care follow ups\n• Provide triage guidance and supportive consultation to other team members, handling escalated complex cases\n• Develop care plans leveraging 5Ms Geriatric best practice framework\n• Develop a wholistic view of patient needs related to Social Determinants of Health\n• Identify existing barriers to engagement with necessary resources and supports\n• Provide education around maintenance of chronic health conditions, as well as available options for behavioral care and social support\n• Serve as liaison between the patient and the direct care providers, assisting in navigating both internal and external systems\n• Initiate care planning and subsequent action steps for high-risk members, coordinating with interdisciplinary team\n• Supporting patients’ self-determination, motivate patients to meet the health goals they have identified\n• Refer patient to necessary services and support across the interdisciplinary team\n• This may include and not limited to: assistance with transportation, food insecurity, navigation of and application for benefits including, Medicaid, HCBS, working to reduce costs associated with prescription medications, organizing schedules of follow up appointments, alleviating social isolation\n• Lead Interdisciplinary CIT Team Meetings when indicated\n• Assess patient’s family and caregiver system, and conduct family meetings with patient and family when needed\n• Participate in creation and facilitation of team training content\n• Participate in and lead CIT interdisciplinary review of and coordination around complex patients\n• Maintain patient confidentiality in accordance with HIPAA\n• Document patient encounters in medical record system in a timely manner\n• Follow general policies related to fire safety, infection control and attendance\n• Perform all other duties and responsibilities as required

Hybrid RN Care/Case Manager

• 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.

RN Clinical Manager

• Conduct Transitions of Care Management for a subset of the patient population, including hospital, obs, and post-acute care follow ups
• Provide triage guidance and supportive consultation to other team members, handling escalated complex cases
• Develop care plans leveraging 5Ms Geriatric best practice framework
• Develop a wholistic view of patient needs related to Social Determinants of Health
• Identify existing barriers to engagement with necessary resources and supports
• Provide education around maintenance of chronic health conditions, as well as available options for behavioral care and social support
• Serve as liaison between the patient and the direct care providers, assisting in navigating both internal and external systems
• Initiate care planning and subsequent action steps for high-risk members, coordinating with interdisciplinary team
• Supporting patients’ self-determination, motivate patients to meet the health goals they have identified
• Refer patient to necessary services and support across the interdisciplinary team
• Lead Interdisciplinary CIT Team Meetings when indicated
• Assess patient’s family and caregiver system, and conduct family meetings with patient and family when needed
• Participate in creation and facilitation of team training content
• Participate in and lead CIT interdisciplinary review of and coordination around complex patients
• Maintain patient confidentiality in accordance with HIPAA
• Document patient encounters in medical record system in a timely manner
• Follow general policies related to fire safety, infection control and attendance
• Perform all other duties and responsibilities as required

Administration

• Provide high-quality support to healthcare providers contacting the call center to initiate referral authorizations or check the status of existing requests
• Serve as a key liaison between providers and internal UM teams, ensuring timely and accurate processing of referral and authorization inquiries in accordance with organizational policies and regulatory guidelines
• Provide non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members
• Respond promptly and professionally to incoming calls from providers seeking to initiate referral authorizations or obtain status updates on existing requests
• Accurately gather, verify, and enter provider and member information into the appropriate systems
• Review and process referral authorization requests according to established UM protocols, policies, and regulatory requirements
• Collaborate with clinical and administrative staff to resolve issues, clarify requirements, and ensure efficient case management
• Provide clear, concise, and courteous information regarding UM processes, documentation requirements, and referral guidelines
• Monitor call queues and manage multiple tasks to maintain service level agreements and minimize provider wait times
• Identify and escalate complex or urgent cases to the appropriate clinical or supervisory staff as needed
• Maintain thorough documentation of all interactions and transactions in accordance with company standards
• Participate in ongoing training and quality assurance activities to maintain up-to-date knowledge of UM policies and procedures
• Adhere to all applicable privacy, confidentiality, and compliance regulations

Branch Director - Home Health

Sr Compliance RCM & Coding Auditor

Hybrid RN Care/Case Manager

RN Clinical Manager

Hybrid RN Care/Case Manager

Utilization Management Administration Coordinator - Phone Intake