Clinical Operations Manager

Job Description

At CenterWell Home Health, we are committed to providing personalized and comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery, or hospitalization. As a Clinical Operations Manager, you will play a crucial role in overseeing all direct care patient services provided by clinical personnel. This position is focused on both home health clinical quality assurance and home health clinical operations initiatives.

Responsibilities

• 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.
• Reviews available patient information related to the case, including disciplines required, to determine home health or hospice needs.
• 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.
• 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.
• 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.
• 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.

Requirements

• Graduate of an accredited School of Nursing.
• 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 required.
• Homecare Homebase (HCHB) experience, preferred.
• CMS PDGM billing knowledge and/or experience, preferred.

Benefits

• Normal Hours of Operation: M-F / 8a-5p (ET)
• On-Call Expectation: Yes, rotating on-call shift.