RN/Registered Nurse QA Clinical Manager, Home Health - Raleigh, NC

Become a part of our caring community and help us put health first

Work Schedule : Full-time/40 Hours

Position Type : On-site

Branch Location : Raleigh, NC

There is a $10K sign-on bonus associated with this role

This is not a remote or work-from-home position. This position requires you to sit on-site at our Raleigh, NC branch location.

The RN Clinical Manager coordinates and oversees all direct care patient services provided by clinical personnel. This role is a focused on both 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 the 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.

• Responsible for and oversees the delivery of care to all patients served by the location. Receives case referrals. Reviews available patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet admission criteria and make the decision to admit patients to service. Assigns appropriate clinicians to a case, as needed.

• Instructs and guides clinicians to promote more effective performance and delivery of quality home care services and is available at all times during operating hours to assist clinicians as appropriate.

• Assists clinicians in establishing immediate and long-term therapeutic goals, in setting priorities, and in developing patient Plan of Care (POC).

• Monitors cases to ensure documentation is in compliance with regulatory agencies and requirements of third-party payers. Ensures final audits/billing are completed timely and in compliance with Medicare regulations.

• Coordinates communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning.

• Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals.

• Participates in sales and marketing initiatives.

• Supervises all clinical employees assigned to a specific location. Responsible for the overall direction, coordination, and evaluation of the location. Carries out supervisory responsibilities in accordance with Company policies and procedures.

• Handles necessary employee corrective action and discipline issues fairly and objectively, in consultation with the Human Resources Department and the Executive Director/Director of Operations.

• Participates in the interviewing, hiring, training, and development of direct care clinicians. Evaluates their performance relative to job goals and requirements. Coaches staff and recommends in-service education programs, when needed. Ensures adherence to internal policies and standards.

• Assesses staff education needs based on own the review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts regular staff education as needed.

• Analyzes situations, identifies problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles.

• Responsible for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, for appropriateness of care, delivery, and documentation requirements.

• Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. Competently performs patient care assignments and staff management activities.

• Provides direct patient care on an infrequent basis and only in times of emergency.

• Acts as Branch Director in his/her absence.

• Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical documentation meets internal standards.

• Participates in performance improvement activities, maintains ongoing clinical knowledge through internal and external training programs. Provides interpretation of knowledge and direction to staff.

• Maintains relationships with referral/community sources. Participates in professional organizations and conducts care-related programs.

• Performs other related duties as assigned or requested.

Use your skills to make an impact

Required Experience/Skills:

• 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 care experience is required, preferably home health.

• Management and people leadership experience, required.

• OASIS experience, required.

• OASIS certification (HCS-O, COQS, and/or COS-C), highly desired.

• Homecare Homebase (HCHB) experience, required.

• CMS PDGM billing knowledge and/or experience, required.

Additional Information

• Normal Hours of Operation: M-F / 8a-5p (ET)

• On-Call Expectation: Yes, rotating on-call shift.

• Branch Size: 460+ Census (3. 5 STAR rating)

• Annual Bonus Eligible: Yes, eligible for the annual incentive bonus which has pay-outs both quarterly and annually.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $76,800 - $105,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowin.