JOB SUMMARY: Provides clinical oversight and serves as the principal liaison between medical providers and nursing staff. Owns clinical regulatory monitoring, high-risk tracking, clinical audit follow-through, and provider-to-nursing workflow reliability. Also functions as the RN for IDT for an assigned caseload shared with the Nursing Participant Care Coordinator.
JOB RESPONSIBILITIES:
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Maintains an assigned caseload of approximately one-half of enrolled participants, adjusted as needed for acuity, enrollment, and coverage.
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Conducts and documents initial, periodic, semiannual and change of status nursing assessments of participants required by regulation, policy, or participant condition.
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Actively participates in the IDT; presents condition, risks, needs, preferences, and priorities; and develops, updates, and evaluates the nursing plan of care.
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Complete participant-specific surveillance, including at least monthly assessment and documentation for active wounds and more often when clinically indicated.
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Performs or coordinates timely post-hospital and post-nursing facility discharge nursing follow-up, including assessment, medication reconciliation, discharge-instruction review, and communication with providers and the IDT.
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Coordinates hospital, nursing-facility, and assisted living admissions, transfers, and discharges; obtains records, maintains facility contact, monitors status, supports discharge planning, and updates the IDT.
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Documents and communicates material changes, risks, refusals, and barriers; escalates urgent matters and verifies follow-through.
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Educates participants and caregivers about conditions, medications, treatments, warning signs, and the nursing plan of care.
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Partners with the Clinical Nursing Manager to align daily execution with acuity, provider priorities, plans of care, and regulatory timeframes.
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Reviews patterns in acute visits, falls, wounds, infections, facility utilization, delayed follow-up, and high-risk events and brings actionable concerns to providers, the IDT, and leadership.
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Facilitates complex case review when clinical needs, services, documentation, or accountability are unclear or stalled.
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Maintains or oversees tracking for wounds, infections, immunizations, falls, hospitalizations, facility stays, homebound and facility visits, transitions, and other required monitoring.
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Monitors compliance with assessment, care-planning, reassessment, service delivery, documentation, transition, and follow-up requirements; reports noncompliance and verifies correction.
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Conducts risk-based clinical audits, validates corrections, analyzes trends, and participates in root cause analyses and corrective action plans with Quality and Compliance.
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Organizes and reports clinical performance and compliance data to clinical leadership and committees as assigned.
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Reviews clinical policies, workflows, forms, and tools for regulatory alignment; supports surveys, audits, record requests, investigations, and plans of correction.
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Provides functional guidance on compliance and coordination without replacing the Clinical Nursing Manager’s personnel supervision or daily operational authority.
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Provides nursing services within RN scope, accepted standards, organizational policy, and the participant’s plan of care.
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Identifies urgent or emergency conditions, initiates appropriate interventions, and promptly escalates to a provider or emergency services.
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Protects participant rights, dignity, confidentiality, choice, and safety and provides person-centered care.
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Completes accurate, timely documentation in the electronic health record and required tracking systems.
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Participates in the 24-hour care delivery system and may provide clinic, field, weekend, holiday, or after-hours coverage when assigned.
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Participates in quality improvement, emergency preparedness, staff education, committees, and other activities as assigned.
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May take call after-hours or on weekends when other nursing staff are not available.
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Participates in the Quality Improvement program.
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Serves on the Quality Committee and appropriate subcommittees.
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Serves on the Compliance Committee and the PACE Administrative Team.
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Perform other appropriate duties as directed by PACE Director.
ESSENTIAL FUNCTIONS:
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Oral and written communication skills
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Interpersonal skills
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Computer skills
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Organizational skills
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Problem solving skills
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Record keeping and reporting skills
SUPERVISORY RESPONSIBILITIES: The Clinical Oversight Manager is the direct supervisor of the Clinical Care Coordinator, Clinical Services Clerk and Clinical Administrative Support Specialist who work in the medical clinic.
QUALIFICATIONS:
Graduate of an accredited school of nursing with a Virginia license to practice as a registered nurse.
One or more years experience with a geriatric population.
Ability to manage people in stressful, difficult and unusual situations.
Medically cleared for communicable diseases with up-to-date immunizations before participant contact.
Criminal history records check at hire.
Drug screen at hire.
WORK SCHEDULE: Full-time, 8:30 a.m. to 4:30 p.m., Monday – Friday. Occasional after-hours call, as needed/directed.
