Clinical Nurse Manager

Job Description

We are currently looking for a Registered Nurse (RN) who will help us with daily operations and serve as a clinical coordinator/manager for our home health agency.

• The RN will function as a Clinical and Admissions Coordinator.
• The nurse will help manage the daily operations of the agency and coordinate patient intake/admissions.
• Reviews and coordinates all needed clinical information before patient admission to ensure the perfect pathway for new patients.
• Communicates with Nurse Manager and teams regarding new patients.

• RN Licensed to practice in Massachusetts.
• Graduate of a School of Nursing or College with an accredited RN Program.

• Minimum 2 years related experience including home healthcare, medical/surgical, and community health and/or experience with a managed care organization.
• Previous intake, liaison or discharge planning experience is preferred.
• Knowledge of home health care standards and practices (preferred)
• Knowledge of medical terminology and treatment modalities of patient diagnoses required
• Knowledge of Medicare, Medicaid and other insurance payers.

• Coordinates referrals from hospitals, physicians, other health facilities, community agencies, and patients and their families between patient account center and the clinical nursing team.
• Demonstrates advanced knowledge of home health and Hospice eligibility criteria and COP for purposes of appropriate referral coordination.
• Prepares and maintains on-call schedule and serves as a backup for on-call.
• Assists with marketing activities as required.
• Serves as a liaison for branch office when dealing with corporate on billing, payroll and collection resolution.
• Primary responsibility for all training (new hires and existing employees); includes Staffing Coordinators and Administrative Support Coordinators, specific to their job descriptions.
• Responsible for tracking and reporting all prior approvals for Medicaid and Managed Care contracts and coordinating all activities with Corporate Billing personnel.
• Responsible for intake of all private pay and insurance cases along with all appropriate paperwork.
• Serves as a liaison between nursing staff, coordinators and corporate regarding client care and payment issues.
• Responsible for coordinating weekly staff meetings with all office staff.
• On a weekly basis review non-compliance reports and remove from cases, all field personnel who are out of compliance with regulatory requirements.
• Participates as required in contract meetings, team meetings and client case conferences.
• Communicates with the patient’s physician, family and others to obtain complete referral information and to assist in organizing resources necessary for patient care prior to admission.
• Triages incoming clinical phone calls from patient’s families and referral sources.
• Collaborates with clinical staff and evaluates patient information/clinical documentation to ensure patient is appropriate for home health care and will be services on the perfect pathway to optimize clinical care.
• Performs thorough clinical assessment of the referral and ensures patient is placed on the perfect pathway and coordinates back with referral source any recommendations.
• Makes preliminary arrangements for any special medical supplies/equipment or for other community services that a patient may require upon admission.
• Communicates with appropriate pod staff to share patient referral information.
• Communicates with pod staff regarding daily capacity and coordinates that with the patient admissions coordinator.
• Documents and obtains MD orders as appropriate.
• Provides support for Utilization Review and Quality Assurance activities as requested.
• Maintains records and reports of referrals and admissions.
• Provides support for the process of obtaining insurance verification and initial authorization for services.
• Communicates with referral sources, families, and physicians to confirm admission.
• Provides specialty customer service referral arrangements with hospitals and physician offices and works closely with liaison staff.
• Participates in the orientation of new staff.
• Assists with liaison functions as necessary.
• Actively participates in activities to attain department goals.
• Participates in ICD-9 coding of referrals.
• Assists in referral entry as needed.
• Upholds the compliance objectives, policies, and procedures of the Foundation and Subsidiaries.
• Performs other related duties of a similar nature and complexity as directed.

Job Types: Full-time, Part-time, PRN, Per diem

Pay: $50.00 - $60.00 per hour

Expected hours: 24 – 40 per week

• Flexible schedule
• Paid time off

• Geriatrics
• Home Health
• Medical-Surgical
• Wound Care

Work Location:

In person