Patient Care Manager | , Grant, | Group

Home Health Patient Care Manager

The Home Health Patient Care Manager is responsible for the overall supervision and coordination of clinical services. Coordinates and supervises an interdisciplinary team of staff to assure the continuity of high quality care to home health patients assigned to the team's area in accordance with physician prescribed plan of care, and all applicable state and federal laws and regulations.

Primary Responsibilities:

• Receives referrals and ensures appropriate clinician and/or therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) 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 to physician orders
• Oversees and assures development, implementation, and updates to the individualized patient plan of care, as appropriate
• Manages and documents phone calls from physicians, clinicians, patients, referral sources, and communicates patient updates/new orders to clinicians
• Uses coordination notes to document, as needed and appropriate
• Reviews assessments and plans of care daily, per assigned workflow, and consults clinicians with recommendations, as appropriate
• Coordinates all aspects of care with all disciplines, physicians, durable medical equipment providers, caregivers/family members, transferring facilities, and any other applicable healthcare providers
• Follows-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 communicates such to clinicians
• Schedules, prepares for, facilitates, and documents case conference/SOC reports and facilitates effective exchange of information across disciplines especially with adverse findings, changes in patient condition, daily and urgent updates, as necessary
• Assists clinicians in coordinating the transfer and discharge of patients from agency services as indicated by the physician
• Receives report from field clinicians prior to scheduled days off on patient status and ongoing needs
• Processes new orders and updates the visit frequency, as appropriate, when the oncall RN takes supplemental verbal orders which alter frequency going forward
• Writes and processes orders when taking verbal orders directly from the physician and communicates such to field clinicians
• Assures payer change documentation is completed properly and timely, as required
• Reviews clinician visit notes weekly to ensure timely, complete, appropriate, and accurate submission of all documentation by field staff
• Takes necessary action to correct adverse findings and communicates trending to clinical director
• Reviews, evaluates, and supervises 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
• Enters infections and incidents/occurrences into the online Risk Management Incident Reporting System, as specified by policy
• Assists in the orientation of new agency personnel
• Provides direction and leadership to clinical team members in collaboration with the clinical director
• Provides direct patient care, as necessary, in accordance to scope of practice and physician orders
• Participates in QAPI program
• Assures compliance with and ensures timely follow up on daily clinical and coding edits
• Directs clinicians in utilizing best practice interventions when finalizing Plan of Care for all patients
• Participates in on-call rotation
• Follows-up with On-Call events daily
• Receives report from weekend and after-hours clinicians admitting new patients
• Completes LHC required learning courses, additional assignments per Executive Director request, as well as any state specific required training per state regulation/practice act requirements
• Directs team in adherence to and participates in the Episode Management process
• All other duties as assigned

You'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:

• Current RN licensure in state of practice
• Current CPR certification
• Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation

State Specific Requirement:

• RN licensure must have no restrictions: IN

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,680 to $134,520 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.