RN Case Manager
The Clinical Manager is responsible for the coordination of high quality, cost-effective patient care. This position is responsible for the operations and operational flow of the agency including performance of and/or oversight of crucial activities including scheduling, staffing, intake, physician communications, billing and reimbursement process, and overall compliance.
- Understands the criteria for acceptance of patient and reimbursement mechanisms as they relate to the delivery of services to patients. Collaborates with the Agency Director regarding referral acceptance, assists in determining qualification and appropriateness for home care services and establishment of frequencies and utilization for new admissions.
- Works closely with the Agency Director regarding coverage, plan of care, and other reimbursement concerns on both an individual and an agency perspective.
- Schedules initial assessments. Ensures that documentation of initial assessments is complete and meets established processing time frames.
- Works closely with Case Coordinators to provide appropriate and adequate staffing.
- Monitors patient utilization to ensure compliance with physician orders, agency, and funded program guidelines. Investigates all unfilled shifts and takes appropriate actions.
- Assists in completing schedules for Case Managers, nurses and other PRN support staff as needed. Ensures Case Managers and nurses submit accurate documentation according to required timelines.
- Implements and approves changes to the patient s plan of care when needed, in consultation with Case Managers and/or direct care staff. Approves all verbal order and initials form to signify approval. Makes changes to the POC calendar and adds medications and treatments to the POC as appropriate and ordered.
- Ensures that recertification's are completed in a timely manner and approves frequencies and utilization of all patients re-certified. Assures compliance with 485/plan of care policies and time frames. Verifies 485 content and appropriateness.
- Performs routine and supervisory visits in the field as needed and as dictated per the state requirements.
- Assists in training and/or orientation of newly hired nurses, caregivers, or other staff as directed.
License Requirements
- Must be a Registered Nurse licensed in the state of practice.
- Minimum of 1 year of Home Care related experience preferred. Supervisory or management experience preferred.
State Specific Requirements
- CT:
Must be a registered nurse with an active license to practice nursing in this state and shall have one of the following:
(1) A baccalaureate degree in nursing and at least two (2) years of full-time clinical experience within the past five (5) years in a home health care agency or related health care facility program which included care of the sick; or (2) An associate degree in nursing and at least three (3) years of full-time clinical experience in nursing within the past five (5) years, at least two (2) of which were in a home health care agency or related health care facility/program which included care of the sick; or (3) A diploma in nursing and at least three (3) years of full-time clinical experience in nursing within the past five (5) years, at least two (2) of which were in a home health care agency or related health care facility/program which included care of the sick. - FL:
Must have at least 1 year of supervisory experience as a registered nurse. - KY:
Must have at least 2 years of experience as a registered nurse in the field of aging or disabilities. - TX:
Must be a registered nurse (RN) licensed in Texas and have at least one year experience as an RN within the last 36 months. - WI:
Must have at least one year of supervisory or administrative experience in personal care services or in a related program. - AR, LA, MD, MO, NC, NY, OH, PA, TN, VA:
No additional requirements.
Skill Requirements
- Prior management experience preferred.
- Knowledge of home care regulations and regulatory requirements is preferred.
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