Clinical Manager

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Responsible for coordinating Home Health intake, coding, and/or quality review activities to ensure standards for care are met and patient care is rendered via collaboration with staff, physicians, ancillary services, patients, and family.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Current unencumbered licensure with the WV Board of Registered Professional Nurses, or appropriate state board where services will be provided, as a registered professional nurse OR current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).

2. Valid driver’s license.

3. CPR certification within 30 days of date of hire.

4. Home Health coaching certification upon hire or within three months of hire.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor’s degree in nursing.

EXPERIENCE:

1. Two (2) years of Home Health experience.

2. Two (2) years of experience in utilization review/chart audit.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an exhaustive list of all responsibilities and duties.  Other duties may be assigned.

1. Responsible for the coordination of intake activities in support of Home Health function.  Case Managers assigned to support intake activities responsibilities include but are not limited to:

·       Obtain and process all referral information, assuring accuracy and completeness.

·       Complete intake function correctly at least 95% of the time.

·       Obtain authorization as necessary.

·       Visit patient prior to discharge at least 95% of the time.

·       Describe home health services as needed.

·       Provide contact information for home health services prior to discharge.

·       Manage face-to-face documentation completion.

·       Provide timely communication a patient referrals.

·       Provide end of month referral reports.

·       Accountable for smooth transition from facility to home.

·       Maintain strong hand off communication 100% of the time.

2. Responsible for the coordination of coding activities in support of Home Health function.  Case Managers assigned to support coding activities responsibilities include but are not limited to:

·       Ensure the proper coding principles are utilized per certification.

·       Maintain coding timeline at or below seven days.

·       Ensure that all comorbidities are added to 95% of the time.

·       Ensure coding is completed by third working day of next month 100% of the time.

·       Responsible for completing coding work queues daily.

·       Ensure coding completed correctly and timely.

·       Maintain ongoing communication to keep management aware of funding specific questions or concerns including staff feedback and key trends.

3. Responsible for the coordination of quality activities in support of Home Health function.  Case Managers assigned to support quality activities responsibilities include but are not limited to:

·       Work with leadership to identify quality focus priorities.

·       Ensure that quality audits care completed timely 100% of the time.

·       Identify, define, and develop reports for leadership on a monthly basis.

·       Maintains a detailed up-to-date dashboard showing red/green performance areas.

·       Maintain strong communication patterns to leadership, including twice monthly quality review sessions.

·       Meet with Home Health staff as needed.

·       Responsible for periodic and annual focused quality improvement projects that are detailed, comprehensive and outlines both improvement plan and results, including additional opportunities and goals.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling are necessary body movements utilized in performing nursing duties throughout the work shift.

2. Must be able to lift, move, and position patients of all weights, with varying amounts of assistance in a fair manner on a regular and recurring basis.

3. Hearing within a normal range required (e.g., to assess breath sounds, heart sounds, apical pulse, monitors, etc.).

4. Visual acuity must be within normal range.  Must be able to perform night driving as necessary for patient care.

5. Must be able to perform heavy work; exerting in excess of 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Exposure to bodily fluids, human tissues, contagious diseases, sharps, and explosive gases.

2. Exposure to toxic gases, fumes, and odors.

3. Exposure to high stress and constant interruptions.

4. Exposure to electrical current.

5. Exposure to radiation from x-rays.

6. Exposure to bad road conditions.

7. Exposure to wind, rain, snow, sleet, mud, high and low temperatures, animals and insects, and hazardous roadways.

8. The majority of work is performed in the patient’s home and may require extensive travel.

9. Subject to unpredictable situations. May be exposed to adverse or unpleasant home environments.

SKILLS AND ABILITIES:

1. Must have the ability to perform concentrated and complex mental activity and frequent involvement in complex and highly- technical situations.

2. Must have the ability to work successfully under highly-stressful conditions, and must be capable of adapting to varying workloads and work assignments on a constant basis.

3. Must have the ability to make sound, independent judgments based on scientific principles, and also be able to collaborate with other multi-disciplinary team members in an appropriate fashion.

4. Must have the ability to comprehend and perform oral and written instructions and procedures.

5. Must have strong communication skills, written and verbal.

6. Must have math skills to enable calculation of drug dosages and infusion rates.

7. Must be able to work weekends, holidays, and all shifts.

8. Must have current Medicare, Medicaid, and private payor regulatory knowledge.

9. Demonstrates flexibility in response to unexpected changes in work volumes, emergencies, staffing, or scheduling changes.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Non-Exempt)

Company:

WMCH Weirton Medical Center

Cost Center:

230 WMCH Pharmacy

Address:

601 Colliers Way

Weirton

West Virginia

Equal Opportunity Employer

 

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.