Clinical Oversight Manager

MOUNTAIN EMPIRE OLDER CITIZENS INC•Big Stone Gap, VA

5h•$76,500 - $84,150•Onsite

About The Position

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.

Requirements

Graduate of an accredited school of nursing with a Virginia license to practice as a registered nurse.
One or more years experience with a geriatric population.
Ability to manage people in stressful, difficult and unusual situations.
Medically cleared for communicable diseases with up-to-date immunizations before participant contact.
Criminal history records check at hire.
Drug screen at hire.
Oral and written communication skills
Interpersonal skills
Computer skills
Organizational skills
Problem solving skills
Record keeping and reporting skills

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 timeframes.
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 provides person-centered care.
Completes accurate, timely documentation in the electronic health record and required tracking systems.
Participates in the 24-hour care delivery system and may provide clinic, field, weekend, holiday, or after-hours coverage when assigned.
Participates in quality improvement, emergency preparedness, staff education, committees, and other activities as assigned.
May take call after-hours or on weekends when other nursing staff are not available.
Participates in the Quality Improvement program.
Serves on the Quality Committee and appropriate subcommittees.
Serves on the Compliance Committee and the PACE Administrative Team.
Perform other appropriate duties as directed by PACE Director.