RN Medicare Case Manager

Deerfield Beach, FL
Case Management, Other
Contract Type
Full Time
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  Maintains the quality of client care in accordance with the Agency's objectives and policies, through planning, coordination, implementation and evaluation of the home health services provided to our clients. Directs the Staffing Coordinator and assists in recommendations to best match the staff to the clients’ needs.
  • Works closely with the Nurses, Therapists, Aides and Assistants in the field to best utilize our Agency personnel to provide quality care to our clients.
  • Provides supervision to our Nurses, Therapists, Aides and Assistants to ensure the quality of services and maintenance of standard for our clients.
  • Reviews and investigates the clinical content, diagnoses, medical history, medications, fee status and other procedures from the records of clients.
  • Directs all field staff toward the appropriate use of community resources.
  • Appraises staff performance during probationary period and annually with the Director of Professional Services.
  • Provides the teaching and counseling, when necessary, to enhance the skills, delivery of services and the professional development of Nurses, Therapists, Aides and Assistants.
  • Identifies and evaluates client needs and appropriateness of home care by reviewing the initial intake/referral screening form before assignment of direct care staff.
  • Participates in community related functions, as necessary.
  • Assists with the orientation of new professional staff to familiarize them with Agency policies and procedures.
  • Sees clients in home setting if requested by Administration.
  • Receives Start of Care documents, ensures proper utilization of personnel to meet patient needs.
  • Ensures appropriate frequency for all personnel visits and must review and approve initial frequencies and changes.
  • Ensures that the new 2018 Conditions of Participation are being met by field staff serving our patients.
  • Performs chart audits at the end of episode and discharge, facilitates obtaining any missing documentation.
  • Evaluates the POC for compliance with the Physician’s orders and assessing if the care is being provided per Complete Home Care’s standards.
  • Monitors the delivery of competent, quality patient care in the home by all disciplines.
  • Maintains an ongoing responsibility for the entire caseload of patients.
  • Assesses the patients who can possible be appropriate for recertification v.s. discharges from our service. Counsels staff on how to process correctly.
  • Reviews and addresses necessary corrections submitted by staff for every patient.
  • Receives all calls from all nurses and therapists calling in with report. Shares concerns voiced by caregivers with the administrative staff in Broward and discusses details with the Director of Professional Services if any escalation of services is deemed necessary.
  • Provides teaching and support to both staff and patient/families. Acts as a facilitator with doctor’s office/staff with our field nurses and therapists.
  • Evaluates and assists scheduling work load for maximum efficiency by evaluating the nursing points (at the minimum) of twice weekly.
  • Conducts Case Care Conferences with the disciplines every sixty (60) days and prn.
  • Abiding and promoting Agency Administrative Policy to field staff.
  • Maintaining and updating patients’ health records daily.
  • Participates and contributes to staff meetings.
  • Assists in resolving conflicts/concerns received from staff, patients/families.
  • Takes reports after every admission from filed RN and makes a note in the patient’s health records to update the team that cares for the patient in the field and updates the Agency’s administrative staff.
  • Ordering, monitoring and requesting labs, when required.
  • Writing Physician’s orders to cover the POC, as needed.
  • Faxes necessary documents to physicians’ offices and facilities, when deemed necessary. Responsible for faxing the Hospital Notification letter(s) to the hospital treating our patients, informing the case managers of our prior relationship to track patients and received a call along with orders when patient is discharged.
  • Completes a review on all OASIS transfers and discharges.
  • Participates in a variety of audits within the company, participates in interdisciplinary team conferences and represents agency in the community as requested.
  • Reviews each nurse's schedule for recertification, discharges, and aide supervisory visits to ensure they are in compliance with Medicare regulations.
  • Reviews weekly schedules with the Scheduling Coordinator in our software system submitted by nurses for changes or updates. Updates Director of Professional Services with any issues and/or concerns.
  • Works with the Staff Nurses and Therapists to assist in determining the need for additional episodes and recertification.
  • Performs other duties as directed by the Administrator or Director of Professional Services.
  • May be requested by Director of Professional Services to fill in for the other supervisory staff when necessary.

  • This position has consistent deadlines to meet, along with follow-up requirements. It is a multi-tasking position.
  • Physical activities will include walking, sitting, stooping and standing with minimal to maximum lifting of clients’ charts and/or records in boxes up to thirty (30) pounds, with assistance from other staff members.
  • Travel is required to and from client's home when supervision of care is scheduled.
  • The ability to communicate well, both verbally and in writing is required.
  • The ability to access clients' homes which may not be routinely wheelchair accessible is required.
  • Hearing, eyesight and physical dexterity must be sufficient to perform a physical assessment of the client's condition and to perform client care.
  • User of multi-line telephone, calculator and medical nursing equipment, i.e.; glucometer, etc.
  • Has access to all client medical records and client financial accounts, which may be discussed with Director of Professional Services, the Administrator, the Executive Director and the Quality Assurance Department. Has access to department’s staff personnel records.
  • Must be a graduate of an accredited School of Nursing
  • Must have a level two background check completed and approved.
  • Must be a Registered Nurse, licensed by the State of Florida.
  • Minimum of two (2) years of experience as a professional nurse in a Medicare Home Health Agency.
  • Must have at least one (1) year of managerial experience and responsibilities.
  • Preferred knowledge of Kinnser™ or similar electronic medical record.