Clinical Manager - Registered Nurse - Medicaid Advantage Waiver Program

Objective:

The Medicaid Clinical Manager is responsible for the clinical oversight, coordination, and quality assurance of the agency’s growing Medicaid population, while leading and implementing the agency’s Continuous Quality Improvement (CQI) Program.

This position ensures regulatory compliance, high-quality service delivery, interdisciplinary coordination, and adherence to Medicaid standards. The role provides direct clinical oversight of Medicaid members, participates in IDT and assessment meetings, conducts required skilled visits, and maintains documentation and provider communication.

In addition, this role serves as the agency’s designated CQI Manager, providing daily oversight of the CQI Plan, quality monitoring processes, and compliance initiatives to ensure the agency remains in good standing on the Certified Agency Report (CAR).

Primary Responsibilities:

Core Values & Agency Leadership

• Reflect the core values of JJBP, LLC dba Home Instead 854 in all interactions.
• Maintain working knowledge of all business policies and procedures, including those governing delegation, supervision, documentation, training, and quality oversight.
• Demonstrate professional leadership, discretion, integrity, and sound clinical judgment.

Medicaid Clinical Oversight

• Coordinate and attend Interdisciplinary Team (IDT) meetings and initial assessments for all new Medicaid members in collaboration with case managers and care teams.
• Complete and maintain accurate documentation in all required Medicaid and agency systems.
• Conduct required skilled nursing visits in accordance with Medicaid standards and agency policy.
• Perform comprehensive member assessments and reassessments as required.
• Monitor and follow up on changes in member condition; initiate appropriate interventions.
• Develop, review, and update individualized plans of care based on assessments and ongoing evaluation.
• Obtain and document physician or provider orders as necessary.
• Communicate effectively with all internal and external care professionals involved in the Medicaid member’s care.
• Coordinate with Home Instead departments to ensure proper service delivery and compliance with care plans.
• Ensure all documentation reflects nursing interventions, member responses, and compliance with Medicaid requirements.

Continuous Quality Improvement (CQI) Oversight

• Serve as the agency’s designated CQI Manager in compliance with Oklahoma Medicaid Services Unit (MSU) requirements.
• Maintain active MSU approval in the electronic system to ensure continued listing on the Certified Agency Report (CAR).
• Develop, implement, and oversee the agency’s Continuous Quality Improvement (CQI) Plan in accordance with state and ADvantage requirements.
• Provide oversight of CQI processes including quality monitoring, audits, corrective action plans, and performance improvement initiatives.
• Implement quality safeguards designed to meet state and federal regulations.
• Monitor compliance with the Oklahoma Home Care Act and all applicable Medicaid standards.
• Lead internal audits and quality reviews to ensure documentation accuracy and service quality.
• Identify trends, risks, and opportunities for improvement; develop corrective strategies as needed.
• Attend all required ADvantage CQI trainings.
• Maintain authority to implement quality initiatives and enforce compliance standards.

Staff Oversight & Clinical Supervision

• Provide supervision of Care Professionals as required.
• Support training efforts to ensure compliance with personal care and Medicaid standards.
• Assist in evaluation of staff performance related to quality and regulatory adherence.

Secondary Responsibilities:

• Assist with service coordination and Care Professional staffing related to Medicaid members as needed.
• Participate in interdisciplinary or internal meetings as required.
• Provide education to families or staff regarding Medicaid services and quality standards.
• Support agency strategic planning related to quality and Medicaid growth initiatives.

Education / Experience Requirements:

• Actively licensed Registered Nurse (RN)
• One (1) year paid professional experience serving aging or disabled populations providing direct care in a home-like setting. (Preferred)
• One (1) year working with Medicaid ADVantage Waiver Members (Preferred)
• One (1) year of administrative and/or managerial experience in quality improvement, process improvement, or auditing, including personnel oversight responsibilities (hiring, training, evaluation, discipline, and performance management). (Preferred)

Supervisory Responsibilities:

• Supervise Care Professionals as applicable.
• Maintain authority and responsibility for quality assurance activities, staff performance oversight, personnel training, and quality-related strategic initiatives.

Knowledge, Skills, and Abilities:

• Strong clinical assessment skills.
• Excellent written and verbal communication skills.
• Ability to work independently and maintain confidentiality.
• Strong organizational skills.
• Ability to manage multiple priorities with variable scheduling demands.
• Ability to develop and implement quality improvement plans.
• Proficiency in agency technology systems and Microsoft Office programs.
• Professional appearance and demeanor.
• Strong knowledge of Medicaid regulations and home care standards (Preferred)

Additional Requirements:

• Must possess a valid driver’s license.
• Must maintain valid auto insurance.
• Must be willing to travel within service area.
• Must maintain active applicable licensure.
• Availability to work variable hours, including occasional evenings or weekends as needed.

Pay: $70,000.00 - $90,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Retirement plan
• Vision insurance

Work Location: In person

Salary : $70,000 - $90,000