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

ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING:

• Receives referrals and ensures appropriate clinician and/or therapist 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 clinician diagnostic tests, 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 conferences/SOC reports and facilitates effective exchanges 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 on-call 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 agency-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.
• Other appropriate tasks and special projects as assigned.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

QUALIFICATIONS & REQUIREMENTS FOR THE POSITION:

• 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.

SUPERVISORY RESPONSIBILITIES:

• May supervise the workload of employees doing similar or related work in the same department.

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Job may require heavy use of office equipment, including computer, tablet, and phone.
• Must have the reasonable ability to stand, walk, sit, use hands to finger, handle, feel, reach, balance, see, talk, hear, and drive. Must be reasonably capable of lifting over thirty (30) pounds.
• Significant portions (> 50%) of daily assignments may require travel to client/resident/patient locations or other work sites, via car or public transportation.
• Work schedule may occasionally require evening, night, holiday, or weekend assignments.

Home Care Solutions, an affiliate of The Pennant Group (NASDAQ: PNTG), is the employer for this position as stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health, hospice, and home care agencies and senior living communities located throughout the US. Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at http://www.pennantgroup.com.

ACKNOWLEDGEMENT

I have read this job description and fully understand the requirements and notices set forth therein. I hereby accept the position and agree to perform the identified essential functions in a safe manner and in accordance with the Company’s established policies and procedures. I agree to request guidance from my Supervisor if I am unsure of how to interpret any policy.

I further understand that my employment is at-will and thereby understand that my employment may be terminated at-will either by the Company or myself, and that such termination can be made with or without notice.

This position consistently supports and promotes compliance with the Code of Conduct by maintaining the privacy and confidentiality of information, protecting the assets of the agency, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal, State, and local laws and regulations, accreditation and licensure requirements (if applicable), and all policies and procedures.