CWHH - Clinical Manager (contract)

Humana; Denver (CO); On-site; USD 85,000 - 92,000; Full time

Benefits offered by this job

Medical, Dental, Vision

STD

LTD

Life Insurance

401K

Commuter Benefit Program

Job summary

Atrium is seeking a temporary contractor to support CenterWell with clinical case management, documentation, and coordination of care. The role requires an active RN license and minimum nursing experience including home health, with duties spanning OASIS processing, case conferences, and physician order management.

The position includes driving requirements and collaboration with multiple teams to ensure timely, accurate care delivery.

Qualifications

• Must have graduated from an approved school of professional nursing and hold an active RN license.
• Minimum of two years nursing experience and at least one year in home health.
• Supervisory experience is preferred.

Responsibilities

• Ensure client's plan of care is individualized and reassessed when health status changes.
• Complete review of evaluation packets, OASIS and 485s.
• Process OASIS and 485; verify start of care and episode dates in HCHB.
• Manage referrals to ensure assessment visits are scheduled and performed timely.
• Lead weekly Case Conference and address recert/discharge decisions.
• Enter Case Conference notes within 48 hours of meetings.
• Contact physicians to obtain orders for continued service or add-ons.

Skills

Nursing experience

Home health experience

Organization

Communication

Computer skills

Multi-tasking

Education

RN license

Job description

This job posting is for a temporary contractor role as an employee of Atrium assigned to work at CenterWell.

Job Responsibilities

• Clinical - Ensure that the client's plan of care is individualized and appropriate, executed as written and reassessed by the appropriate health care processional when there is a significant health status change in the client's condition, at the physician's request and after hospital discharge.
• Ensure appropriate documentation is completed for all patients transferred to an inpatient facility.
• Complete review of evaluation packets, OASIS and 485s.
• Review both the data submitted via the Mobile Device and via paper to ensure accuracy and follow up on any documentation requires correction.
• Process the OASIS and 485; verify the correct start of care date and episode date range in HCHB.
• Process any unlisted supplies, medications, activity, functional limitations, allergies, etc. that appear on the action screen.
• Follow up on OASIS Assessments that cannot be processed due to Licensed Professional documentation deficiencies.
• Responsible for Referral Intake and Management to ensure that clients receive assessment visits and that these visits are scheduled and performed timely.
• Lead weekly Case Conference and address recert / discharge decisions based on Case Conference findings.
• Review and approve Case Conference coordination notes and attach to Episode Detail Report.
• Enter Case Conference coordination notes within 48 hours of the Case Conference meeting.
• Contact physicians to obtain orders for continued service provision or add-on services.

Our Care Matters

• Review orders as they appear on the action screen.
• Approve or decline as appropriate.
• Follow up with Licensed Professional as necessary when editing an order.
• Enter and approve all orders for tracking purposes and route to Medical Records to be sent for physician signature.
• Ensure any corrections are made by the Licensed Professional who wrote the order prior to approving the order.
• Update the client's medication profile and schedule as applicable via the order.
• Ensure all orders that address frequency have appropriate calendar modification completed.
• Ensure that there are existing orders for requested medical supplies.
• Follow up on orders from the Order Tracking Report when the MRS is unable to retrieve the unsigned order.
• Enter detailed Non-Admit information into HCHB in coordination notes if no visit was made.
• Ensure the Branch Director approved the non-admission.
• Review and process vital sign alert reports.
• Document action, any follow-up and physician notification.
• Review and process all wound score deviations documenting any action and/or follow - up.
• If clinical, may be required to perform patient visits and / or participate in an on call rotation.

Administrative

• Review and follow up on entitlement verification issues.
• Document action in coordination notes.
• Verify benefits and obtain authorization for services on all non-Medicare patients.
• Review On-Call coordination notes reports regularly.
• Follow up on identified deficiencies related to billing claims audit within 24 hours follow receipt of the Billing Claims Held Reports.
• Run the Notification of Missed Visits reports and submit weekly to physicians.
• Act as a backup for the Patient Services Coordinator in rescheduling missed and declined visits and processing reassigned and reschedule requests to ensure timely completion of these tasks.
• If the PSC is not an LVN/LPN, receives lab reports and assesses for normality.
• Forward lab reports to the PSC for faxing to the physician.
• Function as staff nurse PRN.

Skills

• Must have a good understanding of the Federal, State, and Local laws / regulatory guidelines governing the operation of a home health agency.
• Must be organized and able to effectively communicate both orally and in writing.
• Must be capable of multi-tasking while maintaining a professional and friendly demeanor.
• Must be adept at communicating with a broad range of individuals and possess excellent customer service skills.
• Must be competent with computers.

Required

• Oasis.
• Home Care.
• Home Base.
• Home Health Experience.

Qualifications

• Must be a graduate of an approved school of professional nursing and hold an active RN license.
• Must have a minimum of two years nursing experience and one year experience in home health.
• Supervisory experience is preferred.

Requirements

• Must possess a valid state driver's license and automobile liability insurance.
• Must be able to drive an automobile in all types of weather conditions.
• Must have an RN license in the State of employment.

Pay Rate Range

62 - 67 USD hourly

Additional Notes

The individual selected for this role will be offered the role as an employee of Atrium; compensation, medical benefits, fringe benefits and other terms and conditions of employment shall be presented by Atrium upon offer. The pay rate range provided is a reasonable estimate of the anticipated compensation range for this job at the time of posting. The actual pay rate will be based on a number of factors, including skills, competencies, experience, location and/or being pursued and other job-related factors permitted by law. In addition, this role will be eligible for overtime pay, in accordance with federal and state requirements. CenterWell and its subsidiaries comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, ancestry, age, disability, sex, marital status, gender, sexual orientation, gender identity, or religion. CenterWell and its subsidiaries do not exclude people or treat them differently because of race, color, national origin, ancestry, age, disability, sex, marital status, gender, sexual orientation, gender identity, or religion.

Benefits Information

Comprehensive Benefits Package available based on eligibility

• Medical, Dental, Vision
• Short-Term Disability (STD)
• Long-Term Disability (LTD)
• Supplemental and Voluntary Life Insurance
• 401(K)
• Commuter Benefit Program