Job Description
The Clinical Manager – Integrated Care plays an essential role in ensuring that participants in contracted organizations experience smooth and effective transitions from hospital to home, helping to reduce hospital readmissions and improve health outcomes. This role provides direct care, participant education, and coordinates with interdisciplinary teams (IDT) to enhance participant outcomes during the post-discharge period. The Clinical Manager also supervises home care staff, ensures compliance with clinical standards, and ensures that participants receive appropriate, high-quality care at home.This position combines oversight of the clinical care of contracted organizations provided at participants' homes with leadership in care transition planning and execution. The Clinical Manager collaborates with hospital discharge planners, physicians, and home care staff to create and implement personalized care plans for participants, ensuring their health needs are met in alignment with organizational goals and best practices.
ResponsibilitiesCollaborate with hospital discharge planners, physicians, and interdisciplinary teams to develop personalized care transition plans for participants discharged from hospital to home.Review participants' medical histories, discharge instructions, medications, and follow-up care to ensure smooth, safe transitions.Ensure that participants understand their post-discharge care plan and provide education on medication management, wound care, and follow-up appointments.Conduct comprehensive home visits to assess participants' health, living environment, and support systems.Monitor participants’ conditions during the transition period, identifying any changes or complications that require adjustments to the care plan.Work with the IDT to ensure comprehensive care coordination and optimize participant outcomes.Provide skilled nursing services in the home, including medication administration, wound care, vital sign monitoring, and support with activities of daily living.Educate participants and families on managing chronic conditions, preventing complications, and improving overall health outcomes.Identify early signs of health deterioration and take proactive measures to prevent readmissions.Supervise, instruct, and guide Nurses, Personal Care Aides (PCAs), and Home Health Aides (HHAs) in the delivery of home health care services.Conduct joint visits with Nurses and other field staff for supervision and competency assessments.Provide mentorship and guidance, acting as a resource for nursing staff and care teams.Monitor adherence to care plans and clinical training protocols, addressing deficiencies when needed in coordination with leadership.Maintain accurate, up-to-date documentation of participant assessments and care provided, ensuring compliance with PACE, LHCSA regulations, and organizational standards.Essential SkillsCurrent active and unrestricted license as a Registered Nurse in New York StateDegree from an NLN-accredited nursing school (RN, BSN preferred)At least 3 years of clinical nursing experience, including 1-2 years in home care or a similar healthcare settingExperience in care transitions, case management, or PACE programs preferredStrong clinical assessment and critical thinking abilitiesExcellent communication skillsCapacity to manage multiple participant cases effectivelyAdditional Skills & QualificationsExperience in geriatrics and managed careAbility to educate participants and families on health managementStrong leadership and mentoring skillsWork Environment
This role involves both office work and field visits to participants' homes. Locations include Rockaway, Flushing, Manhattan, and Seneca. The work environment requires adherence to clinical standards and may involve interaction with various healthcare professionals and participants in their homes.
Pay and Benefits
The pay range for this position is $135000.00 - $140000.00/yr.
Benefit guide available upon request. Includes Medical, dental, vision, 401K and PTO plan. Benefits kick in immediately. 10K signing bonus
Workplace Type
This is a fully onsite position in Flushing,NY.
Application Deadline
This position is anticipated to close on Feb 14, 2025.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & InclusionAt Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
Hiring diverse talent Maintaining an inclusive environment through persistent self-reflection Building a culture of care, engagement, and recognition with clear outcomes Ensuring growth opportunities for our peopleThe company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.