Health Underwriting Manager jobs in Oceanside, CA

JOB DESCRIPTION SUMMARY

The Clinical Manager Must coordinate patient care assignments and referrals and be available during all operating hours. The Clinical Manager will assure that patient needs are continually assessed and met and that care plans are individualized and continually updated.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

• Coordinates and oversees all direct care patient services provided by clinical personnel.
• Develops, plans, implements, analyzes and organizes clinical operations for specific location managed.
• 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.
• Reviews case referrals and available patient information related to case, including disciplines required, to determine home health needs.
• Identifies patients who may benefit from Palliative Care services and, if so, directs the admission to staff members trained in Palliative Care services.
• Accountable to ensure patients meet admission criteria and makes final decision to admit patients to service.
• Supervises the assignment of appropriate clinicians to case and oversees the delivery of care to all patients in service area.
• 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 in compliance with regulatory agencies and requirements of third party payers. Insures final audits/billing are completed timely and in compliance with Medicare regulations.
• Supervises all clinical employees assigned to specific location. Responsible for the overall direction, coordination and evaluation of the location. Carries out supervisory responsibilities in accordance with Company policies and procedures.
• Supervises and instructs RN case managers to provide on-going communication between team members, attending physicians, and caregivers to ensure the appropriateness of care and outcome planning.
• Handles necessary employee corrective action and discipline issues fairly and objectively, in consultation with the Human Resources Department and the Administrator.
• 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 review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of assessment, creates and conducts regular staff education as needed.
• Analyzes situations, identifies problems, identifies and evaluates alternative courses of action through utilization of Performance Improvement principles.
• Provides direct patient care on an infrequent basis and only in times of emergency.
• Acts as Director of Clinical Services in 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.
• Participates in performance improvement activities, maintains ongoing clinical knowledge through internal and external training programs.

POSITION QUALIFICATIONS

• Registered nurse with current licensure to practice professional nursing in the State.
• Bachelor?s degree in Nursing from an accredited program by the National League for Nursing. Master?s degree in health care preferred.
• The Clinical Manager shall qualify for the position by fulfilling the requirements under one of the following categories:
• Five years of management experience in a home health or related health care organization, at least one year of which was a supervisory or administrative capacity.
• A registered nurse with four years experience in a home health agency, primary care clinic or health facility, at least one year of which was in a supervisory or administrative capacity.
• Demonstrated ability to supervise and direct professional administrative personnel.
• Knowledge and expertise in clinical decision-making and Quality Management review and evaluation.
• Ability to market and deal tactfully with customers and the community.
• Must be a licensed driver with an automobile that is insured in accordance with state and/or Organization requirements and is in good working order.
• Has excellent observation, verbal and written communication skills.
• Knowledge of business management, governmental regulations and Joint Commission standards.