Team Manager Home Care

The Team Manager is the leader of the Patient Care Team and that member of the team whose function is to : supervise, evaluate and coordinate the various component members of the interdisciplinary team; assure continuity of care from admission to discharge or transfer to bereavement; serve as patient advocate and coordinator for other social service and health care providers in the community who are involved in the care of the team’s patients; assume responsibility for the maintenance of patient records from intake through discharge or transfer to bereavement.

Patient Care Services

• Directs all patient care services for the team, including volunteer and bereavement, and ensures that services are rendered as integrated components of the interdisciplinary plan of care.
• Reviews information on all pending patient admissions, all new admissions (assessments and history) and “alive” discharges to assure that eligibility and appropriateness criteria are met.
• Collaborates with both the team physician and the attending physician regarding palliative care measures for pain and symptom management.
• Assures complete and accurate data and documentation are available to make recertification decisions and further assures that those decisions are made on a timely basis.
• Reviews all imminent “alive” discharges to assure effective discharge planning.
• Monitors the type and level of team services provided (staffing, medications, HME, supplies, level of care changes to inpatient and continuous care, etc.) to assure that they are appropriate and responsive to patient / family needs and expectations.
• Manages the team schedule and assures coordination of services 24 hours a day, 7 days a week to all patients on the team.
• Facilitates team meeting, assuring interdisciplinary input into the update and revision of the plan of care in concert with the changing needs and expectations of the patient and family.
• Participates in on-call rotation.

Staff Supervision and Management

Quality Improvement / Regulatory Compliance

Customer Service / Sales / Marketing

Cost Containment

Professional Development

QUALIFICATIONS

EDUCATION

SPECIAL INSTRUCTIONS TO CANDIDATE