RN Clinical Operations Manager, Home Health

Humana Inc. • Columbus, GA

71d • Onsite

About The Position

The RN Clinical Operations Manager coordinates and oversees all direct care patient services provided by clinical personnel. This role is a focused on both home health clinical quality assurance and home health clinical operations initiatives. Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed.

Requirements

• Associate degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) strongly preferred.
• Active and unrestricted Registered Nurse (RN) license or Compact State RN license with authorization to practice in the state of Georgia.
• Proof of current CPR card and/or BLS certification.
• Valid driver's license, auto insurance and reliable transportation.
• A minimum of 2 years of experience as a Registered Nurse (RN).
• Management and people leadership experience is required.

Nice To Haves

• Background in home-based care settings, including home health, hospice, or palliative care is strongly preferred.
• OASIS experience is highly desired. OASIS certification (HCS-O, COQS, and/or COS-C), preferred.
• Homecare Homebase (HCHB) experience is strongly preferred.
• Foundational knowledge and basic understanding of CMS PDGM is strongly preferred.

Responsibilities

• 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. Receives case referrals. Reviews available patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet admission criteria and make the decision to admit patients to service. Assigns appropriate clinicians to a case, as needed.
• 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 following 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.
• Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals.
• Participates in sales and marketing initiatives.
• Supervises all clinical employees assigned to a specific location. Responsible for the overall direction, coordination, and evaluation of the location. 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.
• Responsible for the QA/PI activities. 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.
• Acts as Branch Director in his/her absence.
• Interprets Company standards and Company policies and procedures to ensure compliance with external regulatory authorities and ensures that caregiver clinical documentation meets internal standards.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees