Clinical Case Manager

Job description

Job Title: Clinical Case Manager

Company: Pavilion Medical Home Care

Job Description:

Pavilion Medical is seeking a dynamic and experienced clinical case manager for our Home Health division. The ideal candidate will possess proven leadership and case management abilities, along with a strong background in clinical home health care.

Key Responsibilities:

• Oversee the development, implementation, and updates of individualized patient care plans, ensuring they reflect the patient's needs and comply with Medicare requirements.
• Ensure physicians’ orders are legible if taken verbally and transcribed appropriately per policy and procedure
• Ensure patients’ status is assessed on an ongoing basis and pertinent information is gathered and documented
• Notify physicians of significant changes in status
• Document and complete charting for all patient visits within 24 hours
• Coordinate all aspects of patient care across various disciplines, including physicians, durable medical equipment providers, caregivers, family members, and other healthcare providers.
• Ensure that care is appropriate, reasonable, and meets Medicare and home health eligibility criteria.
• Oversee the determination of patient home health benefits.
• Manage and document phone calls from physicians, clinicians, patients, and referral sources. Communicate patient updates, new orders, and changes in condition to the clinical team, ensuring seamless care transitions.
• Continuously assess patient needs, monitor the quality of care provided, and make necessary adjustments to care plans based on physician orders and patient condition. Follow up on lab results, diagnostic tests, and significant patient condition changes to ensure timely physician notification and care plan modifications.
• Utilize coordination notes for documentation as necessary. Review assessments, plans of care, and field nurse notes weekly to ensure timely, accurate, and complete submission of documentation. Take corrective actions on adverse findings and communicate trends to the clinical director.
• Enter infections and incidents/occurrences into the online Risk Management Incident Reporting System as required by policy. Ensure compliance with Medicare's quality and safety standards.
• Evaluate service delivery through random patient visits, medical record reviews, and case conferences to ensure the appropriateness of care, proper utilization of resources, and adherence to Medicare guidelines.
• Schedule, prepare for, facilitate, and document case conferences and SOC reports. Ensure effective information exchange across disciplines, especially regarding adverse findings or urgent updates.
• Assist clinicians in coordinating patient transfers and discharges from agency services as indicated by the physician, ensuring all Medicare and insurance documentation is completed properly and promptly.
• Participate in the on-call rotation, following up with on-call events daily and receiving reports from weekend and after-hours clinicians admitting new patients.
• Provide direction and leadership to clinical team members in collaboration with the clinical director.
• Write and process verbal orders from physicians and communicate them to field clinicians. Assure that payer change documentation is completed correctly and on time.
• Provide direct patient care when necessary, following the scope of practice, Medicare regulations, and physician orders.
• Participate in the Quality Assurance and Performance Improvement (QAPI) program. Direct clinicians in utilizing best practices when finalizing care plans for all patients.
• Complete required learning courses and additional assignments as requested by the Director of Nursing, including state-specific training mandated by regulations.
• Perform other duties as assigned.

Requirements:

• LPN or RN Required
• At least Two years of Home Health Care experience is required
• Requires the ability to work in a multicultural environment.
• Demonstrate a commitment toward the agency's policies and mission.
• Excellent communication skills
• Must possess knowledge of windows applications, MS Word, Excel and related software.
• Ability to supervise, inspire and Manage clinicians to achieve optimal patient care.
• Ability to work with minimal supervision.
• Ability to prioritize and organize client case load.
• LPN or RN License preferred but not required.

Job Type: Full-time

Pay: $60,056.00 - $82,000.00 per year

Schedule:

• Monday to Friday

Experience:

• Home health: 2 years (Preferred)

Work Location: In person