Overview Oversees the clinical, financial, and quality operations and administration of a designated branch in accordance with VNS Health policies, procedures and standards of practice. Is also responsible for ensuring compliance with all applicable government regulations. Works under general direction. • Oversees the execution of plans designed to meet identified metrics, including financial, clinical, quality, customer experience and others as applicable. • Evaluates branch operations; analyzes trends in volume, utilization, and other business drivers to understand the impact these factors have on financial performance. Recommends and implements operational changes based on analysis. • Works with Vice President to ensure branch targets are met. • Ensures that plans of care are individualized and appropriate, executed as written, and reassessed by the appropriate health care professional. • Oversees Clinical Chart Reviews and HR/Operations Audits. Develops corrective plans and reviews with leadership; implements plans as appropriate. • Completes and distributes Weekly Audit Report to leadership. Identifies trends and areas of concern; makes recommendations for improvements and executes approved plan. • Ensures readiness for on-site surveys and other external audits. • Reviews and approves accounts payable. • Ensures that end of episode billing is completed timely and outstanding claims are kept to a minimum. • Ensures deficiencies related to the internal and external audits are addressed and corrected per action plans. • Audits and approves visit and non-visit payroll activities in HCHB; creates payroll batches each pay period. • Completes, reviews, and processes evaluation packets, OASIS and 485s. Reviews data submitted to ensure accuracy; follows up on any documentation that requires correction as required for team backup. • Approves all non-admissions prior to the non-admit decision being made by the office or field staff. Reviews and processes Non-Admits if a visit is made and the determination is made to pay for the visit. • Leads weekly IDT meetings to review/discuss patient status/issues. Determines if patients that are planned for discharge meet the requirements for Management and Evaluation or any other skilled service. • Participates in review process of ADRs and Denials and ensures timely submission. • Monitors referral/intake dashboards and reports. Works collaboratively with the Business Development team to achieve targets. • Monitors staff action screens. • Ensures adequate staffing on weekday, weekends and holidays. • Collaborates with Quality Improvement to monitor complaints/incidents and other quality metrics. • Participates in Business Development initiatives, as needed. • Performs all duties inherent in a senior managerial role. Approves staff training, hiring, promotions, terminations and salary actions. Prepares and ensure adherence to the department budget. • 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 in New York State Required Education: Bachelor's Degree or Master’s degree in Nursing or equivalent work experience Required Work Experience: Minimum of six years of nursing experience in community health Required Minimum of two years managerial experience Required Prior utilization management or care management experience Required Thorough knowledge of home care regulations and clinical practice Required Knowledge of training and adult learning techniques Preferred Effective oral/written communication and organizational skills Required Proficient with personal computers, including MS Word, Excel Required Pay Range USD $58.30 - USD $77.72 /Hr. About Us VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.