Sr Case Mgr RN

UnitedHealth Group

23d

About The Position

Explore opportunities with Christus Homecare, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. The Home Health Patient Care Manager and RN Hybrid is responsible for the supervision and coordination of clinical services and provides and directs provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. Coordinates and supervises an interdisciplinary team of staff to assure the continuity of high quality care to home health patients assigned to the team's area in accordance with physician prescribed plan of care, and all applicable state and federal laws and regulations. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

Current RN licensure in state of practice
Current CPR certification required
Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation

Responsibilities

Receives referrals and ensures appropriate clinician and/or therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits
Coordinates determination of patient home health benefits, medical necessity, and ongoing insurance approvals
Ensures patient needs are continually assessed and care rendered is individualized to patient needs, appropriate and reasonable, meets home health eligibility criteria, and is in accordance to physician orders
Manages and documents phone calls and new orders from physicians, clinicians, patients, referral sources, and communicates patient updates/new orders to clinicians
Uses coordination notes to document, as needed and appropriate
Receives report from weekend and after-hours clinicians admitting new patients
Coordinates all aspects of care with all disciplines, physicians, durable medical equipment providers, caregivers/family members, transferring facilities, and any other applicable healthcare providers
Follows-up on lab and other clinical diagnostic test, physician contact, and significant changes in the patient condition to ensure adequate physician notification, follow-up, and needed plan of care modifications and communicates such clinicians
Schedules, prepares for, facilitates, and documents case conference/SOC reports and facilitates effective exchange of information across disciplines especially with adverse findings, changes in patient condition, daily and urgent updates, as necessary
Assists clinicians in coordinating the transfer and discharge of patients from agency services as indicated by the physician
Receives report from field clinicians prior to scheduled days off on patient status and ongoing needs
Follows-up with On-Call events daily
Assures payer change documentation is completed properly and timely, and required. Reviews clinician visit notes weekly to ensure timely, complete, appropriate, and accurate submission of all documentation by field staff
Takes necessary action to correct adverse findings and communicates trending to clinical director
Reviews, evaluates, and supervises service delivery to ensure appropriateness of care and utilization of services, equipment, and supplies through activities such as random patient visits, medical record reviews and case conferences
Enters infections and incidents/occurrences into the online Risk Management Incident Reporting System, as specified by policy
Assists in the orientation of new agency personnel and provides direction and leadership to clinical team members in collaboration with the clinical director
Provides high quality clinical services within the scope of practice and within infection control standards, in accordance with the plan of care, and in coordination with other members of the health care team
Consistently meets expected productivity at 50%25 of full time RN level as defined in the Visit Productivity Point Policy
Accurately and timely completes the comprehensive assessments (OASIS) including medication reconciliation. Makes the initial and/or comprehensive nursing evaluation visit, ensures patients meet home health eligibility and medical necessity guidelines as defined by payer source, accurately determines primary focus of care, develops the plan of care within State specific guidelines with the physician, and submits accurate documentation
Directly and/or indirectly supervises care provided by the home health aides and licensed practical vocational nurses, provides instruction as appropriate, and assigns tasks according to State and federal regulations
Provides required supervisory visits
Initiates, develops, implements, and makes necessary revisions to the plan of care in collaboration with the physician and other health care professionals involved in care
Communicates relevant information timely and effectively with appropriate agency staff including but not limited to: any patient care issues or needs, visit assignments, dates of scheduled visits, and schedule changes to scheduler, orders and OASIS data sets, coding requests, schedule home visits, to coordinate care with other clinicians
Communicates timely and effectively with physicians, patients, and family members to ensure quality care and service excellence