Clinical Team QA HH Manager Registered Nurse San Antonio Texas - Optum : Job Details

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.The CTM Quality Assurance Nurse, with the assistance of other QA Nurse(s), performs concurrent clinical record reviews for compliance to federal and state rules and regulations and agency policies; monitors factors which directly and indirectly influence the care rendered to our members. Performs audits of all Oasis, daily clinician visits, therapy evaluations, therapy visits, home health aide visits in preparation for billing. The Clinical Team Manager coordinates patient care on all activities and assumes responsibility for continuity, appropriateness and quality of services delivered within the home health department through oversite of the quality review of clinical documentation submitted by staff. The Clinical Team Manager assists with the day-to-day scheduling of staff, monitors performance of staff, assists in the orientation of staff and serves on committees to improve operations. The Clinical Team Manager performs all functions in a professional and ethical manner and collaborates with other members of the health care team to ensure the provision of quality care. The Clinical Team Manager is responsible for verification of appropriate incoming orders obtaining physician orders and completion of orders. Receive and respond to all incoming calls from referral sources or potential patients, exchange information to identify patients' needs, and determine the Company's ability to meet them. The Clinical Team Manager is responsible for communication with the scheduling coordinator in reference to new physician orders and assuring the patient is staffed appropriately along with the reviewing of unassigned patient visits and assisting with the staffing of the patient visits with the appropriate field staff member. Responsible for performing on call for home health department approximately one week per month or dependent on the needs of the department. Clinical Team Manager will work under the supervision of the Clinical Team Manager Lead per branch and/or Director of Nursing for home health for that branch, or VP of home health.Primary Responsibilities:Manages the recruitment, hiring, and development of sufficient clinical and non-clinical staff to ensure the delivery of safe and consistent quality care to all patient/clients 24/ 7Participates and assists in orientation and training of clinical and paraprofessional staffEnsures that on-site supervisory requirements of designated staff are met on a timely basisDemonstrates an effective leadership style and solves problems in an efficient and logical manner after accurately analyzing factsAssures that clinical staff have demonstrated the ability to perform accurate and complete assessments, communicate with physicians, plan for service delivery, plan for discharge, and make excellent professional decisionsManages the assignment of staff, monitoring of daily and weekly schedules, and the matching of caregiver qualifications to patient/client needs and geographical location, Manage quality through patient/client care appraisals and employee supervisionManages documentation to ensure that the patient/client's clinical record meets legal and regulatory requirements, facilitates care, enhances the continuity of care, helps coordinate treatment and evaluation of the patient/client, and establishes medical necessity so payers will reimburse for the services that are providedDevelops and maintains a working knowledge of all services and resources available within the company and the community. Directs staff to meet patient/client needs through the identification and use of all available resourcesEnsures that a client's plan of care is executed as written and per physician ordersEnsures that a reassessment of a client's needs is performed by the appropriate health care professionalWhen there is a significant health status change in the client's condition; at the physician's request; or after hospital dischargeAnnual evaluations of staff according to company policy and procedures and federal/state regulationsManages ongoing skill evaluations to assure that the staff's abilities are consistent with the needs of individual patient/clients and the marketplaceSupervises clinical processes by managing staff and ensuring flow of information and documentation from inquiry through discharge of all patient/clientsProvides support and documentation needed to facilitate reimbursementProvides information that enables the collection and root-cause analysis of data to identify opportunities for improvement, develops/oversees the development and implementation of action plans that result in continuous quality improvementAssists in the coordination of patient services, to include lab reports, updated patient reports, and interdisciplinary communicationReceives and coordinates patient referrals from case managers, physicians, and other referral sourcesParticipates in interdisciplinary care conferences, Agency programs and management functions, as assignedMonitors documentation and paper flow to ensure records are accurate and timely and adhere to Medicare and other payer guidelinesEnsures that clinical notes, supply log/visit logs are accurate and turned into the office according to Agency policyInvestigates patient/family complaints promptly and takes corrective action as neededMakes home visits to provide patient care as neededRecognizes and reports life threatening situations and responds appropriatelyDemonstrates knowledge of emergency procedures and responds appropriatelyParticipates in the Agency's endeavors for accreditation, licensing and professional recognition according to state, federal or CHAPs requirementsAssists Director of Clinical Services in the development of Performance Improvement Plan reports to include achieved goals, opportunities for improvement, statistical data and projectionsParticipates in home care Performance Improvement Program activities to continuously improve the quality of patient careServes as a resource person for clinical staff and management in matters pertaining to Performance ImprovementParticipates in periodic review of clinical records to promote quality patient careEducates clinical staff on documentation standards and patient care as neededMonitors assigned cases to ensure compliance with requirements of third party payersAttends all required in-service programs to maintain comprehensive home care knowledge base within the review year, as assigned by supervisorDemonstrates effective time management skills by completing assignments within projected time framesExpresses verbal and written communication in a clear, positive and cooperative mannerDemonstrates personal responsibility with regard to attendance and punctualityPromotes Agency philosophy, mission statement and administrative policies to ensure quality of careMaintains privacy and confidentiality with regard to all patient, staff and Agency informationProvides positive, supportive communication to patients, families, visitors, physicians and other personnelPromotes the Agency image by adhering to the Dress CodeMeets productivity requirements based on Agency standardDemonstrates knowledge and observance of the Patient's Bill of RightsFollows all infection control, standard precautions, and safety guidelines/standards per Agency policyFollows the appropriate chain of command in all forms of communicationDemonstrates flexibility, enthusiasm and willingness to cooperate while working with others or in place of others as necessaryMust be flexible with work schedule, able to work weekdays-on call and weekends per assigned schedulePerforms other duties as assignedCompetencies:Maintain privacy and confidentiality with regard to all patient, staff & agency informationProblem solving SkillsInterpersonal SkillsCommunication Proficiency (Oral & Written)Project & Time Management SkillsEthical Conduct - follows appropriate chain of commandAdaptability & DependabilitySafety & SecurityThoroughnessPosition Type/Expected Hours of Work:Employee must be available during the core work hours and must work 40 hours each week to maintain full-time statusTravel:Travel is expected for this positionYou'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:Graduate of an accredited school of nursingCurrent licensure as a Registered Licensed Nurse in good standing with the Board of Nurse Examiners for the State of TexasMaintains certification in Basic Cardiac Life Support Course C. Familiarity with medical terminology and equipment. Additional education and/or experience may be required by individual state regulations. click apply for full job details.