Review all Medicare and other episodic payers’ clinical records at the local level to assure appropriate documentation for reimbursement. This review includes verification of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians, adherence to the care plan, and evidence of communication between disciplines.
Oversee the maintenance of clinical records and files to comply with Conditions of Participation (COPs), using measurements, as licensure, certification, and accreditation results.
Audit charts for clinical oversight and compliance and adherence to the Medicare guidelines.
Manage clinical activities, including patient assessments, care plan development, service level determination, on-site field visits, and the implementation/coordination/maintenance/evaluation of care plans.
Be responsible for direct supervision of clinical staff. Participate in the recruitment, interviewing, selection, and orientation of team members; evaluate their performance relative to job goals/requirements; coach staff and recommends in-service education programs and ensure adherence to internal policies/standards. Manage the assignment of clinical associates.
Discuss operational issues, update staff on new/changed regulations and review records/documentation to ensure regulatory and in-house compliance.
Be accountable for financial responsibility related to budget goals through utilization, documentation, providing appropriate and accurate patient care, case mix weight, and appropriate utilization of delivery of patient care. Participate in short and long-term planning of agency’s goals for growth and strategic development.
Conduct and/or delegate the assessment and reassessment of patients, including updating of care plans and interpreting patient needs (including frequencies), while adhering to Agency, physician, and/or health facility procedures/policies.
Coordinate communication between team members/attending physicians/caregivers to ensure the appropriateness of care and outcome planning and ensures compliance through review of documentation and care coordination activities.
Participate in performance improvement activities, maintain ongoing clinical knowledge through internal/external training programs, provide interpretation of knowledge and direction to staff.
Identify clinical problem areas and documents deficiency trends in a proactive approach.
Educate administrative and clinical associate staff in the correction of these deficiencies.
Assist with quality improvement and Medicare compliance training program. Utilize MPH/CorsoCare approved reference materials to resolve inadequacies.
Review HIS documents for accuracy and completeness prior to locking and submitting data, electronically. Explain and mentor clinicians and staff on COP’s.
Educate and mentor clinicians one on one (in person or over the phone) regarding concerns, questions, accuracy of charting, and other related documents, that are being reviewed.
Facilitate the ICD-10 coding of the Plan of Treatment based on admission data and patient assessment documentation.
Assures adherence to privacy and security standards provided by all federal, state, and local authorities of the Health Insurance Portability and Accountability Act (HIPPA) and other applicable laws.
Oversees referral and admission process to ensure a smooth transition for new patients and families, and that communication to the referring provider is complete and timely.
Oversees QAPI program for improved patient outcomes and/or overall patient and family satisfaction ratings.
Conducts performance evaluations in a timely, measurable and objective manner. Communicates this information to the Administrator. Oversees the annual skills competency assessments of all clinical staff, either directly, or by delegation of peer.
Required Experience for Clinical Manager / Registered Nurse:
Currently licensed Registered Nurse in the State of Michigan.
Registered Nurse with at least 4 years’ experience in Hospice Home care
At least 3 years’ experience in Hospice leadership in a similar role
CPR certification preferred.
Excellent communication skills
Compliance with accepted professional standards and practices.
Self-directed with the ability to work with little supervision.
Avid team player
Consistently maintains a positive attitude which promotes team and optimal performance.
To provide client-centered, quality and comprehensive care to those requiring health services at home.
To provide a physical, emotional and social support system at home and within the community.
To help clients function as independently as possible in their homes by working closely in an interdisciplinary team effort collaborating with physicians to develop the best course of home treatment.
To extend the highest level of courtesy and service to clients, caregivers, visitors and each other.
Michigan Premier Home Care and Hospice subscribes to the concept of health as stated by the WORLD HEALTH ORGANIZATION. Health is a state of mental, social and physical well being and not merely the absence of disease or infirmity. To the end, the personnel of the agency are committed to providing high quality care and promoting attainment of the maximum physical, mental and social conditions of the client.