Market Clinical Manager - RN (Eastbank Team)
Company Name:
Peoples Health, Inc.
To assist the Market Clinical Director in organizing and managing the daily operations of the regional market. Interacts with regional team saff to assure that effective care coordination and appropriate service utilization is occurring.
The Market Clinical Manager provides oversight of staff resources engaged in care coordination activities of members receiving services from inpatient and outpatient facilities as well as members requiring assistance with health care coordination and support in other environments.
Leadership/Supervision
Reports to the Market Clinical Director and has the management responsibilities of Regional Team staff to include:
o Care Coordinators Registered Nurses
o Care Coordinators Social Workers
o Clerical Assistants
o Administrative Assistants
Participates in the ongoing evaluation of staff performance as well as participation in the annual performance appraisal process for assigned staff
Coaches staff for the purpose of enhancing individual job performance
Contributes to the professional development of staff
Participates in the orientation and training of new staff
Develops on-going education for staff in partnership with the Market Clinical Director
Census
Conducts daily census reviews of all new admissions with the Care Coordinators (nurses and social workers)
Assigns review of existing patients for discharge or continued-stay determinations
Reviews census daily and adjusts staffing as needed to meet the census demands
Ensures daily census is completed according to the established process and time frames
Directs the completion of the monthly census within the established time frame
Daily meetings with the Hospitalist for census review, as applicable
Face to face meetings with the Physician Advisor for census review/team conference
Review/Discharge Planning
Completes real-time reviews and updates daily catastrophic logs when discharge occurs
Coordinates discharge planning needs such as Home Health, DME and/or other appropriate levels of care transfers (SNF, LTAC, Rehab) with the hospital (facility) case management staff
Serves as a catalyst for early intervention in the discharge planning process with hospital (facility) case management staff
Reviews catastrophic cases daily for trends and referrals to Case Management, Social Services, Disease Management, etc.
Prepares and leads case reviews as appropriate and when requested
Completes Service Forms in accordance with department policy including time-lines and Standards of Documentation
Quality
Identifies and reviews quality issues/indicators with Physician Advisor for initial investigation
Submits completed Quality Indicator Form to the QI department for final review, possible further investigation and presentation to the Regional Team Quality Caucus
Evaluates daily operations processes for adherence to procedures
Identifies opportunities for process improvement
Diploma or degree in nursing; BSN highly preferred. Current Louisiana RN license a must. Minimum of 3 years nursing experience in a clinical or similar setting. Previous Utilization Review and Case Management experience highly preferred. Previous supervisory experience and managed care experience a plus! Strong verbal and written communication skills needed. Must be able to effectively interact with a multifaceted medical professional staff. Computer navigation skills with experience in a windows environment also required.Estimated Salary: $20 to $28 per hour based on qualifications.
Peoples Health, Inc.
To assist the Market Clinical Director in organizing and managing the daily operations of the regional market. Interacts with regional team saff to assure that effective care coordination and appropriate service utilization is occurring.
The Market Clinical Manager provides oversight of staff resources engaged in care coordination activities of members receiving services from inpatient and outpatient facilities as well as members requiring assistance with health care coordination and support in other environments.
Leadership/Supervision
Reports to the Market Clinical Director and has the management responsibilities of Regional Team staff to include:
o Care Coordinators Registered Nurses
o Care Coordinators Social Workers
o Clerical Assistants
o Administrative Assistants
Participates in the ongoing evaluation of staff performance as well as participation in the annual performance appraisal process for assigned staff
Coaches staff for the purpose of enhancing individual job performance
Contributes to the professional development of staff
Participates in the orientation and training of new staff
Develops on-going education for staff in partnership with the Market Clinical Director
Census
Conducts daily census reviews of all new admissions with the Care Coordinators (nurses and social workers)
Assigns review of existing patients for discharge or continued-stay determinations
Reviews census daily and adjusts staffing as needed to meet the census demands
Ensures daily census is completed according to the established process and time frames
Directs the completion of the monthly census within the established time frame
Daily meetings with the Hospitalist for census review, as applicable
Face to face meetings with the Physician Advisor for census review/team conference
Review/Discharge Planning
Completes real-time reviews and updates daily catastrophic logs when discharge occurs
Coordinates discharge planning needs such as Home Health, DME and/or other appropriate levels of care transfers (SNF, LTAC, Rehab) with the hospital (facility) case management staff
Serves as a catalyst for early intervention in the discharge planning process with hospital (facility) case management staff
Reviews catastrophic cases daily for trends and referrals to Case Management, Social Services, Disease Management, etc.
Prepares and leads case reviews as appropriate and when requested
Completes Service Forms in accordance with department policy including time-lines and Standards of Documentation
Quality
Identifies and reviews quality issues/indicators with Physician Advisor for initial investigation
Submits completed Quality Indicator Form to the QI department for final review, possible further investigation and presentation to the Regional Team Quality Caucus
Evaluates daily operations processes for adherence to procedures
Identifies opportunities for process improvement
Diploma or degree in nursing; BSN highly preferred. Current Louisiana RN license a must. Minimum of 3 years nursing experience in a clinical or similar setting. Previous Utilization Review and Case Management experience highly preferred. Previous supervisory experience and managed care experience a plus! Strong verbal and written communication skills needed. Must be able to effectively interact with a multifaceted medical professional staff. Computer navigation skills with experience in a windows environment also required.Estimated Salary: $20 to $28 per hour based on qualifications.
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