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Visiting Nurse Service of New York Clinical Review Manager in New York, New York

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.

VNSNY is an equal opportunity employer M/F/D/V
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