Clinical Review Manager

Overview

Oversees the completion and approval of all clinical utilization documentation, including Start of Care, Re-certification, Resumption of Care, Follow up (SCIC), Transfer, Discharge OASIS, and Evaluation visits. Ensures clear and appropriate visit utilization using evidence-based practices to provide positive clinical outcomes and efficient use of resources.

Identifies and addresses inter-professional performance issues related to documentation and provides individualized performance evaluation assessments to clinical leadership and staff. Collaborates with leadership to promote patient centered care and enhance employee engagement in all roles. Works under general supervision.

• Reviews and approves evaluation documentation, OASIS and Patient Plan of Care. Assures consistency with the comprehensive assessment and the patient plan of care. Reviews data submitted from the field staff to ensure accuracy and follows up on any documentation that requires correction.
• Ensures that service utilization correlates with assessment data and is aligned with the suggested visit and other utilization to support effective and efficient outcomes.
• Processes OASIS and Patient Plan of Care; verifies the correct start of care date and episode date range. Follows up on OASIS Assessments that cannot be processed due to document deficiencies. Addresses such deficiencies with clinician. Identifies and escalates trends with leadership.
• Processes any unlisted supplies, medications, activity, functional limitations, allergies, etc. that appear on the action screen to assure completion of the Patient Plan of Care.
• Ensures that appropriate Care Types are selected based on client’s medical condition and staffs’ assessment data.
• Reviews and processes ROC and Discharge Assessment Data to ensure accuracy; follows up on any documentation that requires correction.
• Ensures patient's plan of care is completed and reassessed by the appropriate health care professional when there is a significant health status change in the patient's condition, at the physician's request and after hospital discharge. Ensures appropriate documentation is completed for all patients transferred to an inpatient facility.
• Educates clinicians to follow best practices in documentation and OASIS completion. Identifies areas of concern and works with Education resources to revise courses as needed.
• Develops, assigns and completes training activities in conjunction with other departments (Education, Quality, etc.), based on individual clinicians’ learning needs and capabilities. Provides direction to staff via telephone in response to any situations arising in the field with regard to documentation.
• Provides coaching, education, performance evaluation assessments, co-visits and counseling and discipline, as needed, to clinicians regarding job performance. Maintains complete and timely documentation of performance management activity and clinician progress. Evaluates clinician’s performance for annual performance review process.
• Collaborates internally to ensure timely and appropriate processing of patient care for optional outcomes and scheduling process
• Identifies, resolves and/or escalate issues to improve outcomes and efficiency in patient care, clinician work and organizational processes.
• Participates in special projects and performs other duties as assigned.

Qualifications

• Licenses and Certifications: License and current registration to practice as a Registered Professional Nurse, Physical Therapist or Occupational Therapist or Speech Language Pathologist licensed in New York State required
• OASIS certification required within one year of job entry date.
• Education: Bachelor's Degree required or
• Master's Degree required
• Work Experience: Minimum of three years clinical experience in community health care required
• Prior clinical management, utilization management or care management experience preferred
• Proficiency in Microsoft Office applications required
• Demonstrated analytical skills required

Pay Range

USD $98,200.00 - USD $130,800.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.

Responsibilities

• Reviews and approves evaluation documentation, OASIS and Patient Plan of Care. Assures consistency with the comprehensive assessment and the patient plan of care. Reviews data submitted from the field staff to ensure accuracy and follows up on any documentation that requires correction.
• Ensures that service utilization correlates with assessment data and is aligned with the suggested visit and other utilization to support effective and efficient outcomes.
• Processes OASIS and Patient Plan of Care; verifies the correct start of care date and episode date range. Follows up on OASIS Assessments that cannot be processed due to document deficiencies. Addresses such deficiencies with clinician. Identifies and escalates trends with leadership.
• Processes any unlisted supplies, medications, activity, functional limitations, allergies, etc. that appear on the action screen to assure completion of the Patient Plan of Care.
• Ensures that appropriate Care Types are selected based on client’s medical condition and staffs’ assessment data.
• Reviews and processes ROC and Discharge Assessment Data to ensure accuracy; follows up on any documentation that requires correction.
• Ensures patient's plan of care is completed and reassessed by the appropriate health care professional when there is a significant health status change in the patient's condition, at the physician's request and after hospital discharge. Ensures appropriate documentation is completed for all patients transferred to an inpatient facility.
• Educates clinicians to follow best practices in documentation and OASIS completion. Identifies areas of concern and works with Education resources to revise courses as needed.
• Develops, assigns and completes training activities in conjunction with other departments (Education, Quality, etc.), based on individual clinicians’ learning needs and capabilities. Provides direction to staff via telephone in response to any situations arising in the field with regard to documentation.
• Provides coaching, education, performance evaluation assessments, co-visits and counseling and discipline, as needed, to clinicians regarding job performance. Maintains complete and timely documentation of performance management activity and clinician progress. Evaluates clinician’s performance for annual performance review process.
• Collaborates internally to ensure timely and appropriate processing of patient care for optional outcomes and scheduling process
• Identifies, resolves and/or escalate issues to improve outcomes and efficiency in patient care, clinician work and organizational processes.
• Participates in special projects and performs other duties as assigned.

Qualifications

• Licenses and Certifications: License and current registration to practice as a Registered Professional Nurse, Physical Therapist or Occupational Therapist or Speech Language Pathologist licensed in New York State required
• OASIS certification required within one year of job entry date.
• Education: Bachelor's Degree required or
• Master's Degree required
• Work Experience: Minimum of three years clinical experience in community health care required
• Prior clinical management, utilization management or care management experience preferred
• Proficiency in Microsoft Office applications required
• Demonstrated analytical skills required