Clinical Oversight Manager

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Full Time Management Big Stone Gap, VA, US

Salary Range: $76,500.00 To $84,150.00 Annually

JOB SUMMARY:Provides clinical oversight and serves as the principal liaison between medical providers and nursing staff. Owns clinical regulatory monitoring, high-risk tracking, clinical audit follow-through, and provider-to-nursing workflow reliability. Also functions as the RN for IDT for an assigned caseload shared with the Nursing Participant Care Coordinator.

JOB RESPONSIBILITIES:

• Maintains an assigned caseload of approximately one-half of enrolled participants, adjusted as needed for acuity, enrollment, and coverage.
• Conducts and documents initial, periodic, semiannual and change of status nursing assessments of participants required by regulation, policy, or participant condition.
• Actively participates in the IDT; presents condition, risks, needs, preferences, and priorities; and develops, updates, and evaluates the nursing plan of care.
• Complete participant-specific surveillance, including at least monthly assessment and documentation for active wounds and more often when clinically indicated.
• Performs or coordinates timely post-hospital and post-nursing facility discharge nursing follow-up, including assessment, medication reconciliation, discharge-instruction review, and communication with providers and the IDT.
• Coordinates hospital, nursing-facility, and assisted living admissions, transfers, and discharges; obtains records, maintains facility contact, monitors status, supports discharge planning, and updates the IDT.
• Documents and communicates material changes, risks, refusals, and barriers; escalates urgent matters and verifies follow-through.
• Educates participants and caregivers about conditions, medications, treatments, warning signs, and the nursing plan of care.
• Partners with the Clinical Nursing Manager to align daily execution with acuity, provider priorities, plans of care, and regulatory time frames.
• Reviews patterns in acute visits, falls, wounds, infections, facility utilization, delayed follow-up, and high-risk events and brings actionable concerns to providers, the IDT, and leadership.
• Facilitates complex case review when clinical needs, services, documentation, or accountability are unclear or stalled.
• Maintains or oversees tracking for wounds, infections, immunizations, falls, hospitalizations, facility stays, homebound and facility visits, transitions, and other required monitoring.
• Monitors compliance with assessment, care-planning, reassessment, service delivery, documentation, transition, and follow-up requirements; reports noncompliance and verifies correction.
• Conducts risk-based clinical audits, validates corrections, analyzes trends, and participates in root cause analyses and corrective action plans with Quality and Compliance.
• Organizes and reports clinical performance and compliance data to clinical leadership and committees as assigned.
• Reviews clinical policies, workflows, forms, and tools for regulatory alignment; supports surveys, audits, record requests, investigations, and plans of correction.
• Provides functional guidance on compliance and coordination without replacing the Clinical Nursing Manager’s personnel supervision or daily operational authority.
• Provides nursing services within RN scope, accepted standards, organizational policy, and the participant’s plan of care.
• Identifies urgent or emergency conditions, initiates appropriate interventions, and promptly escalates to a provider or emergency services.
• Protects participant rights, dignity, confidentiality, choice, and safety and…