RN Clinical Operations Manager, Home Health

RN Clinical Operations Manager

The RN Clinical Operations Manager coordinates and oversees all direct care patient services provided by clinical personnel. This role is focused on both home health clinical quality assurance and home health clinical operations initiatives.

Responsibilities include :

• Developing, planning, implementing, analyzing, and organizing clinical operations for a specific location managed.
• Conducting / delegating 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.
• Managing 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.
• Instructing and guiding 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.
• Assisting clinicians in establishing immediate and long-term therapeutic goals, in setting priorities, and in developing patient Plan of Care (POC).
• Monitoring 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.
• Coordinating communication between team members / attending physicians / caregivers to ensure the appropriateness of care and outcome planning.
• Working in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals.
• Participating in sales and marketing initiatives.
• Supervising 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.
• Handling 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.

Education and Certifications

Education :

License / Certifications :

Required Experience / Skills

Additional Information

Scheduled Weekly Hours and Pay Range

Scheduled Weekly Hours : 40

Pay Range : $77,200 - $106,200 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and / or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our 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.

About Us

About CenterWell Home Health : CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.

About CenterWell, a Humana company : CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE : HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.