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Clinical Review Manager

Overview

Completes and approves clinical utilization documentation, including Initiation and Evaluation visits, Starts of Care,Certification of Terminal Illness (CTI), Routine Visits, Recertifications, Hospice Transfers, Revocations and Death/Live Discharges. Ensures that documentation meets regulatory standards and VNSNY policy and procedures. Ensures clear and appropriate visit utilization using evidence-based practices to provide positive clinical outcomes and efficient use of resources. Identifies inter-professional performance issues related to documentation and provides individualized performance evaluation assessments to clinical leadership and staff. Works under general supervision.


Responsibilities
  • Rreviews, /edits, and /approves workflow tasks in collaboration with the interdisciplinary team. Assures consistency with plan of care (POC). Reviews visit data submitted from the field staff to ensure accuracy and follows up on any documentation that requires correction.
  • Ensures that POC correlates with assessment data and is aligned with the identified visit utilization.
  • Processes start of Care (SOC) POC and associated CTIs; verifies correct dates and episode date range.  Follows up on SOC assessments that cannot be processed due to document deficiencies.  Addresses such deficiencies with clinician.
  • Processes any unlisted supplies, medications, activity level, functional limitations, allergies, etc. that appear on the workflow screen to assure completion of the POC.
  • Ensures that appropriate disciplines are selected based on client’s POC and staffs assessment data.
  • Reviews and processes Recert POC and Discharge Assessment Data to ensure accuracy; follows up on any documentation that requires correction.
  • Reveiws and processes Hospice transfers, revocations and death/live discharges timely.
  • Ensures patient's POC is completed and reassessed  when there is a decline in the patient's condition.  Ensures appropriate documentation is completed for all patients that have a change in level of care.
  • Educates clinicians to follow best practices in documentation and POC completion.  Identifies areas of concern and works with Clinical  Director and Team Managers.
  • Provides direction to staff via telephone in response to situations arising in the field with regard to documentation.
  • Provides daily and/or weekend back-up coverage for other Clincal Review Managers  during absences, which includes processing workflow, approving schedules, reassigning visits, etc.
  • Participates in special projects and performs other job duties as required.

Qualifications

Licensure:  License and current registration to practice as a Registered Professional Nurse in New York State required.

Education:Bachelor’s or Master’s degree in Nursing or equivalent work experience required.    . 

Experience: Minimum of three years nursing experience in hospice care required.  Prior utilization management or care management experience preferred. Proficiency in HCHB and Microsoft Office applications required.  Demonstrated analytical skills required. 


ABOUT US

The Visiting Nurse Service of New York (VNSNY) is one of the nation's largest not-for-profit home- and community-based health care organizations, serving the five boroughs of New York City, and Nassau, Suffolk, and Westchester Counties. For over 125 years, VNSNY has been committed to improving the health and well-being of people through high-quality, cost-effective health care in the home and community. We offer a wide range of services, programs, and health plans to meet the diverse needs of our patients, health plan members, and clients from before birth to the end of life. On any given day, VNSNY employees - including nurses, rehabilitation therapists, social workers, home health aides and other professionals - deliver compassionate care, unparalleled medical expertise, and 24/7 solutions and resources to approximately 40,000 individuals in our care helping them to live the best lives possible in their homes and communities.