Nursing Utilization Review Jobs in Rochester, NY

Job Title: Quality Review Team Manager-Home Care
Department: Home Care Operations
Location: 330 Monroe Avenue Rochester, NY 14607
Hours Per Week: 40 hours per week
Schedule: 8:30am-5:00pm Monday through Friday
Rochester Regional Health Home Care is the only home care provider in the region to earn a CMS 5-Star Quality of Patient Care rating, placing its CHHA among the top 3.5% of agencies nationwide. In addition, CHHA was recognized by U.S. News & World Report as a "High Performing Home Care Agency," further highlighting its commitment to exceptional patient care and clinical excellence.
Position Summary
The Team Manager is responsible for the overall direction and supervision of clinical staff including community health nurses (CHNs), registered nurses and LPN's (for nursing), physical therapists, occupational therapists, speech language pathologists, physical therapy assistants, and certified occupational therapy assistants (for rehab) in the delivery of direct clinical services to designated Rochester Regional Health Homecare and Hospice patients. This responsibility includes participation in the recruitment, training and orientation of new staff in the performance of their duties. The incumbent is responsible for ensuring that multidisciplinary patient care is delivered in an effective, efficient manner.
Key Responsibilities:
• Assumes role as an informed "in-charge" person.
• Affects the behavior of others to follow the vision of the agency.
• Creates an environment that encourages teamwork, positive attitudes, and high morale.
• Faces difficult challenges with resolve.
• Makes decisions with confidence and in support of the agencies mission and goals.
Organizational/Service Management
• Works with other administrative staff to develop appropriate plans for company operations.
• Participates in the development and implementation of policies and procedures that guide and support the provision of services and administrative practices of the agency.
• Participates in review and revision of existing policies for continued accuracy and appropriateness.
• Participates in departmental budgeting.
• Demonstrates knowledge of the agency structure, systems and processes.
• Conducts business and operations meetings and submits required reports in a professional and timely manner
• Maintains updated knowledge of other existing community resources and directs the staff CHN's/RNs to utilize resources appropriately.
• Participates in on-call scheduling, as needed.
Operations Management
• Plans, organizes, and coordinates activities of the Clinical Team in assigned area.
• Ensures workflow processes are timely and cost-effective.
• Ensures clinical area(s) are compliant with Federal, and State, regulations, as well as agency policies and procedures and holds staff
accountable.
• Participates in preparation of and monitors compliance with agency budget.
• Ensures fiscally responsible delivery of patient care according to established Case Management policies and procedures.
• Ensures attendance of appropriate staff at regular Case Conferences and Interdisciplinary team meetings (IDT) to ensure that appropriate
clinical interventions are performed in a timely and efficient manner and that care is well coordinated among disciplines.
• Regularly chairs group staff meetings
• Ensures quality patient care delivered by clinical staff utilizing objective outcome-based criteria.
Participates in Performance Improvement process of agency and monitors staff compliance.
• Communicates regularly with superiors and staff.
• Utilizes available management data to monitor clinical operations.
• Ensures that all for service are assigned to an appropriate Professional Home Visitor (PHV) for follow up in a timely manner. Manages
workload and productivity of assigned staff.
• Regularly reviews clinical documentation of visits to ensure that the delivery of appropriate care is documented and is in compliance with
federal, state and/or agency documentation requirements. Participates in the Quality Assurance programs, as required.
• Disseminates appropriate information regarding agency policy and procedural changes to staff, and ensures that they are expeditiously and
appropriately implemented.
• Responsible for ensuring that appropriate utilization guidelines and practice standards are followed by nurses in the delivery of nursing
service.
• Coordinates patient service needs to provide continuity in 24-hour coverage.
• Works in conjunction with Home Care Plus managers to assure continuity of care from acute to chronic needs.
Development of People
• Interviews, hires, evaluates and terminates all clinical and clerical staff assigned to Clinical Department.
• Ensures staff complies with mandated orientation, education, and have timely performance appraisals.
• Provides an environment that assures staff is knowledgeable and demonstrate competency and service excellence. Motivates staff to fulfill
their maximum potential.
• Assists staff in identifying their developmental goals.
• Counsels and takes appropriate disciplinary action when departmental policy or professional standards are violated. Informs superiors per
agency policy.
• Assists in the development and implementation of orientation, training and activities for clinical staff, as needed. Performs at least one
supervisory visit per calendar year.
Service Excellence
• Exemplifies excellent customer relations and is held accountable for service excellence of staff within the assigned area of responsibility.
• Develops and maintains effective interpersonal relations with superiors, peers, subordinates, and customers.
• Implements and enforces the confidentiality policies and procedures of agency.
• Works cooperatively on an Intra-Departmental and Inter-Departmental level toward the achievement of agency goals.
• Investigates and responds to customer complaints in a timely fashion.
• Participates in local organizations and activities related to community health services.
• Participates in local, state, and national associations activities as related to home health.
• Accepts other duties as assigned willingly and pleasantly
• Consistently demonstrates high standards of integrity by supporting the Rochester Regional Health mission and values and adhering to
the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these
requirements.
• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
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.
Desired Attributes:
• 2 years' experience as a professional home visitor in a certified home health agency or equivalent professional experience in a related capacity.
• Working knowledge of community health nursing practices and resources preferred.
• Must demonstrate strong interpersonal and teamwork skills.
• Must have ability to travel
Minimum Qualifications
Bachelor's degree required; master's preferred.
Required Licensure/Certification:
Valid NYS license in Social Work, or Physical Therapy, or Occupational Therapy or Speech Therapy.
EDUCATION:
LICENSES / CERTIFICATIONS:
PHYSICAL REQUIREMENTS:
M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.
PAY RANGE:
$70,000.00 - $100,000.00
CITY:
Rochester
POSTAL CODE:
14607
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.
Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.