Eventus WholeHealth has an opportunity for a Lead administrative role in our Chronic Care Management (CCM) department designed to enhance patient engagement, compliance and long-term health status of the patients we serve.
This newly created role will oversee and manage the CCM team and implement processes to manage patient populations. You will also work with providers, patient advocates, care coordinators and third-party affiliates to introduce policy and procedure that builds commitment to patient centric accountable and coordinated patient care which maximizes continuity and improves communication across a fragmented delivery system.
RN degree required with a BSN preferred. Strong analytical and problem solving skills. Ability to build consensus toward pivotal change in traditional health care business models and cultures.
This position plays a key role in the oversight of all home health activities and chronic care management (CCM) and triage services. The individual in this role will ensure the overall success, quality, accuracy and billing of CCM and Home Health/Hospice. Promotion of health prevention activities and oversight/management of chronic conditions is paramount in the successful individual.
Essential Duties and Responsibilities:
- Chronic Care Management/Triage Services:
- Daily oversight for the CCM/triage program including programs enhancements, and continuous improvement efforts for the department.
- Responsible for the accuracy of billing and documentation.
- Provide training, supervision, and oversight to clinical support services employees who are assisting with the completion CCM/triage activities and documentation.
- Work with multidisciplinary team including providers, clinical support employees, patients and surrogate decision makers to identify appropriate health goals for each patient and to accurately measure goals.
- Use clinical knowledge (e.g. illness, disease processes, diagnosis and treatments) to promote the continuity and coordination of care, including transitions, to achieve cost-effective quality outcomes.
- Conduct effective, ongoing evaluation of care plans and make adjustments as appropriate.
- Maintain client files with attention-to-detail and accuracy using program policy and procedures.
- Utilize risk stratification, population health, utilization management, quality improvement, care coordination and cost management to achieve measurable goals.
- Home Health/Hospice Services:
- Provide necessary education to providers regarding all regulations/documentation requirements for home health/hospice services.
- Responsible for accurate billing and documentation.
- Review face-to-face documentation and provider encounters to ensure that documentation meets all necessary home health/hospice criteria.
- Supervise clinical services employees and provides continuous review/oversight of all aspects of patient utilization of services; ensuring continued skilled need, monitoring of homebound status; review of documentation in the medical record and maintenance of interdisciplinary communication.
- Regularly re-evaluate each patient’s nursing, therapy, and/or durable medical equipment needs
- Provide training, supervision and oversight to staff members assisting to complete home health documentation
- Regularly communicate with physicians/providers regarding patient’s needs, changes in conditions and obtains physician orders, and with home health/hospice agencies to coordinate patient care plans.
- Develop strong relationships with Home Health and Hospice Agencies.
- Responsible for participating in the recruitment process, selecting, and training departmental employees.
- Ensure employee results by communicating job expectations, planning, monitoring, and appraising job results; coaching, counseling, and discipling employees; developing, coordinating and enforcing systems, policies, procedures, and productivity standards
- Establishes strategic goals for the team and department by gathering pertinent business, financial, service and operations information; identifying and evaluating trends and options, choosing a course of action, defining objectives and evaluating outcomes
- Meets daily average production as set by company standards
- Must effectively communicate with patients, surrogate decision makers, providers and medical assistants to identify any gaps in care which could lead to emergency/crisis situations and possible decompensation in health
- Monitor and report on federal state rules and regulations that may affect Eventus WholeHealth.
- Maintain licensure and attend in-service training as required
- Perform other duties as assigned
Qualifications and Experience
- RN required; BSN preferred
- 5 years’ experience with chronic care management and/or home health requirements
- 2 years of direct supervisory experience in a clinical setting preferred
- RN license required; active and must be maintained
- Medical coding experience preferred
- Strong computer skills including data entry and Microsoft office programs. Intermediate to advanced excel skills required
- Electronic medic record software experience is required
- Demonstrated knowledge of all state, federal, local and accreditation regulations for the delivery of home health services
- Understanding and adherence to HIPAA privacy laws and regulations.
- Strong interpersonal and communication skills
- Must be committed to demonstrating a high-level of customer service at all time
- Strong attention to detail and commitment to quality assurance standards
- Excellent verbal and written communication skills and experience communicating with patients, surrogate family members, and providers and other clinical staff.
- Ability to multi-task, juggle competing priorities, and manage time effectively
- Ability to do some travel to field or customer sites.