Home Health Patient Care Manager
The Home Health Patient Care Manager is responsible for the supervision and coordination of clinical services and provides and directs provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. Provides clinical services within the scope of practice, as defined by the state laws governing the practice of nursing, in accordance with the plan of care, and in coordination with other members of the health care team. Receives referrals, ensures appropriate clinician assignments, evaluate patient orders, and plot start of care visits. Coordinates determination of patient home health benefits, medical necessity, and ongoing insurance approvals. Ensures patient needs are continually assessed and care rendered is individualized to patient needs, appropriate and reasonable, meets home health eligibility criteria, and is in accordance with physician orders. Reviews assessments and plans of care daily, per assigned workflow, and consults clinicians with recommendations, as appropriate. Responsibilities Includes:
- Receiving referrals and ensuring appropriate clinician and/or therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits.
- Coordinating determination of patient home health benefits, medical necessity, and ongoing insurance approvals.
- Ensuring patient needs are continually assessed and care rendered is individualized to patient needs, appropriate and reasonable, meets home health eligibility criteria, and is in accordance to physician orders.
- Overseeing and assuring development, implementation, and updates to the individualized patient plan of care, as appropriate.
- Managing and documenting phone calls from physicians, clinicians, patients, referral sources, and communicating patient updates/new orders to clinicians.
- Using coordination notes to document, as needed and appropriate.
- Reviewing assessments and plans of care daily, per assigned workflow, and consulting clinicians with recommendations, as appropriate.
- Coordinating all aspects of care with all disciplines, physicians, durable medical equipment providers, caregivers/family members, transferring facilities, and any other applicable healthcare providers.
- Following-up on lab and other clinical diagnostic test, physician contact, and significant changes in the patient condition to ensure adequate physician notification, follow-up, and needed plan of care modifications and communicating such to clinicians.
- Scheduling, preparing for, facilitating, and documenting case conference/SOC reports and facilitating effective exchange of information across disciplines especially with adverse findings, changes in patient condition, daily and urgent updates, as necessary.
- Assisting clinicians in coordinating the transfer and discharge of patients from agency services as indicated by the physician.
- Receiving report from field clinicians prior to scheduled days off on patient status and ongoing needs.
- Processing new orders and updating the visit frequency, as appropriate, when the oncall RN takes supplemental verbal orders which alter frequency going forward.
- Writing and processing orders when taking verbal orders directly from the physician and communicating such to field clinicians.
- Assurance of payer change documentation completion properly and timely, as required.
- Reviewing clinician visit notes weekly to ensure timely, complete, appropriate, and accurate submission of all documentation by field staff.
- Taking necessary action to correct adverse findings and communicating trending to clinical director.
- Reviewing, evaluating, and supervising service delivery to ensure appropriateness of care and utilization of services, equipment, and supplies through activities such as random patient visits, medical record reviews, and case conferences.
- Entering infections and incidents/occurrences into the online Risk Management Incident Reporting System, as specified by policy.
- Assisting in the orientation of new agency personnel.
- Providing direction and leadership to clinical team members in collaboration with the clinical director.
- Providing direct patient care, as necessary, in accordance to scope of practice and physician orders.
- Participating in QAPI program.
- Assurance of compliance with and ensuring timely follow up on daily clinical and coding edits.
- Directing clinicians in utilizing best practice interventions when finalizing Plan of Care for all patients.
- Participating in on-call rotation.
- Following-up with On-Call events daily.
- Receiving report from weekend and after-hours clinicians admitting new patients.
- Completing LHC required learning courses, additional assignments per Executive Director request, as well as any state specific required training per state regulation/practice act requirements.
- Directing team in adherence to and participating in the Episode Management process.
- All other duties as assigned.
Education and Experience:
- Current RN licensure in state of practice
- Current CPR certification required
- Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation
Wage negotiable depending upon experience.
Company Overview:
LHC Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. At LHC Group we are proud to offer benefits that support your physical and emotional wellbeing.