Job Description

Purpose

Responsible for supporting the nursing standards of excellence with advanced professional education to deliver high-quality care. Serve the organization as a member of the management team, working alongside all departments and employees to support and oversee the day-to-day operations. Provide guidance, and deliver best practices in achieving the organization's objectives, goals, and mission. Cultivate an environment dedicated to improving experience, enhancing satisfaction and retention. Provides care coordination in a manner that is sensitive to age, gender, sexual orientation, cultural, linguistic, racial, ethnic, religious backgrounds, and congenital or acquired disabilities.

Responsibilities

• Review and ensure effective development and execution of personalized care plans that result in improved satisfaction & outcomes for all participants.
• Facilitate and complete the process of Interdisciplinary Team (IDT) meetings, Service Delivery Requests (SDR), and other meetings. This includes completing the attestations, as needed. Support and collaborate with the Virtual IDT as needed.
• Serve as a manager on call during non-operational hours of the physical sites and be responsible for follow-ups including follow-up documentation and initiating grievances on participants/caregivers’ behalf in a timely manner.
• Responsible for running necessary Clinical Delivery reports.
• Participate and represent the Community Health Nurse (CHN) in all IDT meetings, when required.
• Balance and allocate staffing and related resources throughout the site and ensure adequate team assignments and coverage as a seamless operation.
• Maintain ongoing communication with IDT and necessary parties involved to coordinate care consistent with the participants’ health care needs and goals to support in attaining and maintaining optimal health status.
• Collaborate with clinicians to review UAS and the UAS analyzer system to ensure accuracy of their assessments.
• Ensure all incidents are investigated and addressed accordingly. Ensure Level 2 investigation and documentation are completed in a timely manner in accordance with applicable regulations.
• Ensure documentation for participants is complete and accurate, including but not limited to enrollment, disenrollment, electronic/paper medical records, and other clinical notes.
• Review participants’ charts for quality and address any deficiencies.
• In collaboration with the Transitions in Care Team, provide care management services across sites and communicate with appropriate team members, facilities, discharge planners, and home care coordinators when members are transitioned between care settings.
• Coordinate, facilitate, and arrange for long-term care services in nursing homes, rehab facilities, etc., as needed.
• Monitor care management activities, services, and members’ responses to interventions to determine the effectiveness of the plan of care and the utilization of services and implement changes and adjustments to meet needs and goals.
• Ensure documentation complies with applicable standards and federal/state regulations.
• Maintain up-to-date knowledge about current health-related issues, procedures, evidence-based clinical practices, guidelines, medications, and evolving health and practice standards.
• Recommend and contribute to improvements in services, programs, policies, and procedures to ensure optimum care and services to members.
• Collaborate with the Human Resources Department (HR) in conducting interviews, coaching, and disciplinary actions if needed. Assist in onboarding and professional development training of staff to ensure compliance with policies/procedures/regulations and promote a continuous learning environment focused on growth and advancement.
• Ensure appropriate regulatory compliance is effectively met at all federal and state levels.
• Evaluate the work performance and competency of direct reports, including ongoing informal feedback, counseling/support, and annual performance reviews.
• Ensure that direct reports conduct their duties according to applicable rules, regulations, and the organization’s policies and procedures.
• Investigate and resolve employee grievances and complaints.
• Serve as the Director of Patient Services (DPS) for the LHCSA, as assigned.
• Only act within the scope of the individual’s authority to practice.
• Meet a standardized set of competencies for the specific position description established by the PACE organization before working independently.
• Perform all other duties as assigned.

Qualifications

Education

• Degree from an accredited nursing school (BSN required or five years experience in a healthcare setting).
• Completed NYSED-approved infection control coursework.
• A minimum of 8 education contact hours may include contact hours of mandatory training requirements such as infection control coursework.
• Case Management Certification recommended within two years of employment.

Experience

• Minimum of 2+ years of administrative experience in a management capacity in a certified home health agency, long-term home health care, acute care, medical-surgical, and/or critical care, nursing home experience, or diagnostic & treatment clinic preferred.
• Customer service experience is required.
• Experience with managed long-term care insurance is beneficial.
• Minimum of one year of experience working with a frail or elderly population or, if the individual has less than one year of experience but meets all other requirements, must receive appropriate training from the PACE organization on working with a frail or elderly population upon hiring.
• Supervisory experience is required.

License

• Current active and unrestricted license and registration in New York State as a Registered Nurse required.

Additional Requirements

• Be legally authorized (e.g., currently licensed, registered, or certified if applicable) to practice in the State in which the healthcare professional will perform the function.
• Be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact.

Physical Requirements

• Standing: Up to 6 hours a day.
• Sitting/Stationary Positions: Sedentary work up to 6-8 hours per day.
• Lifting/Push/Pull: Up to 50 pounds; includes patients and equipment.
• Bending/Squatting: Must bend or squat to provide care.
• Stairs/Walking/Climbing: Must be able to travel and navigate stairs/sites daily.
• Agility/Fine Motor Skills: Must handle tools, devices, and supplies with precision.
• Sight/Visual: Must visually assess patients, documentation, and instruments.
• Audio/Hearing and Language Skills: Must listen, speak, and understand clearly.
• Cognitive Ability: Must demonstrate sound reasoning, analysis, and judgment.

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