Registered Nurse (RN) - Manager, Quality Assurance
UnitedHealth Group Inc
San Antonio, TX

Clinical Team QA HH Manager Registered Nurse San Antonio Texas

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The CTM Quality Assurance Nurse, with the assistance of other QA Nurse(s), performs concurrent clinical record reviews for compliance to federal and state rules and regulations and agency policies; monitors factors which directly and indirectly influence the care rendered to our members. Performs audits of all Oasis, daily clinician visits, therapy evaluations, therapy visits, home health aide visits in preparation for billing. The Clinical Team Manager coordinates patient care on all activities and assumes responsibility for continuity, appropriateness and quality of services delivered within the home health department through oversite of the quality review of clinical documentation submitted by staff. The Clinical Team Manager assists with the day-to-day scheduling of staff, monitors performance of staff, assists in the orientation of staff and serves on committees to improve operations. The Clinical Team Manager performs all functions in a professional and ethical manner and collaborates with other members of the health care team to ensure the provision of quality care. The Clinical Team Manager is responsible for verification of appropriate incoming orders obtaining physician orders and completion of orders. Receive and respond to all incoming calls from referral sources or potential patients, exchange information to identify patients' needs, and determine the Company's ability to meet them. The Clinical Team Manager is responsible for communication with the scheduling coordinator in reference to new physician orders and assuring the patient is staffed appropriately along with the reviewing of unassigned patient visits and assisting with the staffing of the patient visits with the appropriate field staff member. Responsible for performing on call for home health department approximately one week per month or dependent on the needs of the department. Clinical Team Manager will work under the supervision of the Clinical Team Manager Lead per branch and/or Director of Nursing for home health for that branch, or VP of home health. Primary Responsibilities: * Manages the recruitment, hiring, and development of sufficient clinical and non-clinical staff to ensure the delivery of safe and consistent quality care to all patient/clients 24/ 7 * Participates and assists in orientation and training of clinical and paraprofessional staff * Ensures that on-site supervisory requirements of designated staff are met on a timely basis * Demonstrates an effective leadership style and solves problems in an efficient and logical manner after accurately analyzing facts * Assures that clinical staff have demonstrated the ability to perform accurate and complete assessments, communicate with physicians, plan for service delivery, plan for discharge, and make excellent professional decisions * Manages the assignment of staff, monitoring of daily and weekly schedules, and the matching of caregiver qualifications to patient/client needs and geographical location, Manage quality through patient/client care appraisals and employee supervision * Manages documentation to ensure that the patient/client's clinical record meets legal and regulatory requirements, facilitates care, enhances the continuity of care, helps coordinate treatment and evaluation of the patient/client, and establishes medical necessity so payers will reimburse for the services that are provided * Develops and maintains a working knowledge of all services and resources available within the company and the community. Directs staff to meet patient/client needs through the identification and use of all available resources * Ensures that a client's plan of care is executed as written and per physician orders * Ensures that a reassessment of a client's needs is performed by the appropriate health care professional * When there is a significant health status change in the client's condition; at the physician's request; or after hospital discharge * Annual evaluations of staff according to company policy and procedures and federal/state regulations * Manages ongoing skill evaluations to assure that the staff's abilities are consistent with the needs of individual patient/clients and the marketplace * Supervises clinical processes by managing staff and ensuring flow of information and documentation from inquiry through discharge of all patient/clients * Provides support and documentation needed to facilitate reimbursement * Provides information that enables the collection and root-cause analysis of data to identify opportunities for improvement, develops/oversees the development and implementation of action plans that result in continuous quality improvement * Assists in the coordination of patient services, to include lab reports, updated patient reports, and interdisciplinary communication * Receives and coordinates patient referrals from case managers, physicians, and other referral sources * Participates in interdisciplinary care conferences, Agency programs and management functions, as assigned * Monitors documentation and paper flow to ensure records are accurate and timely and adhere to Medicare and other payer guidelines * Ensures that clinical notes, supply log/visit logs are accurate and turned into the office according to Agency policy * Investigates patient/family complaints promptly and takes corrective action as needed * Makes home visits to provide patient care as needed * Recognizes and reports life threatening situations and responds appropriately * Demonstrates knowledge of emergency procedures and responds appropriately * Participates in the Agency's endeavors for accreditation, licensing and professional recognition according to state, federal or CHAPs requirements * Assists Director of Clinical Services in the development of Performance Improvement Plan reports to include achieved goals, opportunities for improvement, statistical data and projections * Participates in home care Performance Improvement Program activities to continuously improve the quality of patient care * Serves as a resource person for clinical staff and management in matters pertaining to Performance Improvement * Participates in periodic review of clinical records to promote quality patient care * Educates clinical staff on documentation standards and patient care as needed * Monitors assigned cases to ensure compliance with requirements of third party payers * Attends all required in-service programs to maintain comprehensive home care knowledge base within the review year, as assigned by supervisor * Demonstrates effective time management skills by completing assignments within projected time frames * Expresses verbal and written communication in a clear, positive and cooperative manner * Demonstrates personal responsibility with regard to attendance and punctuality * Promotes Agency philosophy, mission statement and administrative policies to ensure quality of care * Maintains privacy and confidentiality with regard to all patient, staff and Agency information * Provides positive, supportive communication to patients, families, visitors, physicians and other personnel * Promotes the Agency image by adhering to the Dress Code Meets productivity requirements based on Agency standard * Demonstrates knowledge and observance of the Patient's Bill of Rights * Follows all infection control, standard precautions, and safety guidelines/standards per Agency policy * Follows the appropriate chain of command in all forms of communication * Demonstrates flexibility, enthusiasm and willingness to cooperate while working with others or in place of others as necessary * Must be flexible with work schedule, able to work weekdays-on call and weekends per assigned schedule * Performs other duties as assigned Competencies: * Maintain privacy and confidentiality with regard to all patient, staff & agency information * Problem solving Skills * Interpersonal Skills * Communication Proficiency (Oral & Written) * Project & Time Management Skills * Ethical Conduct - follows appropriate chain of command * Adaptability & Dependability * Safety & Security * Thoroughness Position Type/Expected Hours of Work: * Employee must be available during the "core" work hours and must work 40 hours each week to maintain full-time status Travel: * Travel is expected for this position You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Graduate of an accredited school of nursing * Current licensure as a Registered Licensed Nurse in good standing with the Board of Nurse Examiners for the State of Texas * Maintains certification in Basic Cardiac Life Support Course C. Familiarity with medical terminology and equipment. Additional education and/or experience may be required by individual state regulations * Evidence of independent nursing practice in delivering nursing care * 3+ years of experience as a RN in an acute care setting or general medical/surgical setting * Basic knowledge of governmental regulations, Medicare (Medicaid, as required), regulations, and company policies and procedures are required. Good organization, communication, human relations skills, and reliable transportation. Self-motivation, assertiveness and independent decision-making skills * Intermediate PC skills (Excel, PowerPoint, Word, Visio, Outlook, SharePoint) * Demonstrated ability to read and follow written and verbal instructions in English effectively * Demonstrated ability to operate computer terminal, printer, fax and copier machines * Permanent employment is contingent upon the results of the Criminal History Check & Drug Test * This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease Preferred Qualifications: * Experience in a community health or home health setting * Supervisory experience * Home Health Experience * Knowledge of general office procedures * Proven excellent computer skills and knowledge of word processing and excel At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.