Home Health Clinical Manager

Home Health Clinical Manager (RN, BSN)

Job Description

Position Summary

The Home Health Clinical Manager (Registered Nurse) is responsible for overseeing clinical operations, ensuring compliance with Medicare Conditions of Participation (CoPs), and supporting quality patient care delivery within the home health setting. This role provides leadership to clinical staff, oversees patient care coordination, ensures accurate and timely documentation, and manages processes related to Medicare and Medicare Advantage (MA) payer requirements, including authorizations and utilization management.

The Clinical Manager ensures care is delivered in accordance with federal and state regulations, agency policies, and evidence-based practice standards, supporting optimal patient outcomes and survey readiness.

Qualifications

Required

• Active Registered Nurse (RN) license in applicable state
• Bachelor of Science in Nursing (BSN)
• Minimum 2 years home health clinical experience
• Knowledge of Medicare Conditions of Participation (CoPs) and home health regulations
• Experience with Medicare Advantage (MA) payer authorization processes
• Strong clinical assessment and documentation skills
• Experience with OASIS documentation and home health plan of care requirements
• Ability to supervise and support interdisciplinary clinical staff

Preferred

• Previous clinical leadership or supervisory experience
• Knowledge of PDGM reimbursement structure
• Experience working with EMR systems (such as Axxess, Homecare Homebase, WellSky, etc.)
• Familiarity with value-based purchasing and quality outcome measures

Essential Duties and Responsibilities

Clinical Oversight & Staff Leadership

• Supervise and support field clinicians including Registered Nurses, Licensed Practical Nurses, and therapy staff.
• Provide clinical guidance and ensure care delivery meets agency, state, and federal regulatory standards.
• Review and approve plans of care, ensuring services are medically necessary and meet Medicare coverage criteria.
• Provide education and coaching to clinicians related to documentation standards and clinical best practices.
• Participate in interdisciplinary case conferences and care coordination activities.

Regulatory Compliance & Medicare Requirements

• Ensure compliance with Medicare Conditions of Participation (CoPs) and applicable state licensing requirements.
• Monitor clinical documentation to ensure accuracy, timeliness, and support of medical necessity.
• Oversee OASIS assessment accuracy, timeliness, and regulatory compliance.
• Ensure care plans align with physician orders and meet coverage criteria for Medicare reimbursement.
• Maintain survey readiness and assist in preparation for state and federal audits.

Medicare Advantage & Authorization Management

• Demonstrate working knowledge of Medicare Advantage (MA) payer requirements including prior authorization processes.
• Collaborate with intake and billing departments to ensure timely authorization requests and approvals.
• Monitor visit utilization to ensure alignment with payer authorizations.
• Assist clinicians in documenting medical necessity to support payer approvals and continued services.
• Identify and address potential authorization or coverage issues proactively.

Quality Assurance & Performance Improvement

• Participate in Quality Assurance Performance Improvement (QAPI) activities.
• Monitor clinical outcomes, patient satisfaction, and quality indicators.
• Assist in implementing performance improvement initiatives to enhance patient outcomes.
• Support Value-Based Purchasing (VBP) initiatives and agency quality goals.

Care Coordination

• Ensure effective communication between physicians, interdisciplinary team members, patients, and families.
• Address clinical concerns and escalate issues when necessary.
• Support safe transitions of care and appropriate discharge planning.

Skills and Competencies

• Strong understanding of home health regulations and payer guidelines
• Ability to interpret Medicare coverage criteria and clinical documentation standards
• Excellent communication and leadership skills
• Strong organizational and time management abilities
• Attention to detail and commitment to compliance
• Ability to problem solve and support clinical staff effectively
• Knowledge of PDGM reimbursement methodology preferred

Physical Requirements

• Ability to sit, stand, and work at a computer for extended periods
• Ability to travel locally if needed for staff support or patient care oversight
• Ability to communicate clearly in person, by phone, and electronically

Pay: $83,000.00 - $90,000.00 per year

Benefits:

• 401(k) matching
• Cell phone reimbursement
• Dental insurance
• Health insurance
• Paid holidays
• Paid time off
• Vision insurance

Work Location: In person

Salary : $83,000 - $90,000