Clinical Executive Director

• Active Registered Nurse (RN) license
• 5+ years of pediatric home care leadership experience preferred
• Ability to travel between NJ, NY, and CT offices
• Flexibility to support occasional evenings and weekends as business needs require

• Lead the Pediatric portion of daily stand-up meetings; collect and present updates from staff unable to attend
• Provide nursing updates during team huddles, with emphasis on high-revenue and skilled nursing case needs
• Provide direction, competency, coaching, and real-time problem-solving support to nursing team members
• Provide immediate support for urgent clinical or operational matters

• Oversee both caregiver and skilled nursing pediatric cases to ensure service excellence
• Provide hands-on clinical support for cases designated as VIP priority
• Ensure all assessments, start of care visits, and routine visits are completed as scheduled
• Monitor nursing staff compliance with visit requirements and ensure corresponding progress notes are completed
• Ensure nurses are scheduled to be a at start of cares and needed visits
• Manage a caseload of pediatric client’s along with supervising and supporting NY and CT pediatric nurses.

• Ensure timely completion and accuracy of clinical documentation, including:
  • 485s (Plans of Care)
  • IPOs (Interim Physician Orders)
  • Assessments and visit notes
• Ensure corrections are completed promptly in response to compliance or QA review
• Ensure supervisions and reports are being provided to staff
• Review start of care and discharge documentation for completeness and compliance
• Conduct regular self-audits of clinical charts to ensure adherence to DOH standards and agency policy

• Participate in Quality Assurance (QA/QAPI) meetings and initiatives
• Review overdue and upcoming assessments to ensure compliance with regulatory timelines
• Monitor infection control reporting and ensure timely submission by nursing staff
• Ensure incident reports are completed, reviewed, and escalated appropriately
• Track and trend documentation, compliance, and performance issues, implementing corrective actions as needed

• Participate in and/or oversee orientation for new nursing staff
• Support ongoing competency validation and clinical education initiatives
• Assist in the vetting and evaluation of pediatric staff to ensure clinical competency and alignment with agency standards

• Manage and track all insurance authorizations, reauthorizations, and Single Case Agreements (SCAs) to ensure uninterrupted patient services.
• Monitor authorization utilization and proactively initiate renewals prior to expiration to prevent gaps in care.
• Coordinate with physicians, hospitals, discharge planners, case managers, and insurance representatives to obtain and maintain required approvals.
• Prepare, complete, and submit Letters of Medical Necessity (LMNs) and all supporting clinical documentation required for authorization requests, appeals, and continued service approvals.
• Review physician orders, Plans of Care (485s), Interim Physician Orders (IPOs), nursing assessments, and visit documentation to ensure medical necessity is accurately supported.
• Collaborate with clinical leadership and field staff to obtain updated assessments, physician documentation, and supporting records necessary for payer approval.
• Maintain accurate tracking logs for Medicaid, Medicare, Managed Medicaid, commercial insurance authorizations, and Single Case Agreements, ensuring all expiration dates, renewal timelines, and payer requirements are met.
• Coordinate recertification documentation and ensure all required clinical records are completed, signed, and submitted within payer and regulatory timeframes.
• Prepare and organize documentation for Medicare, Medicaid, Managed Care, Department of Health (DOH), Recovery Audit Contractor (RAC), Unified Program Integrity Contractor (UPIC), and other payer or regulatory audits.
• Respond to payer requests for additional documentation, medical records, and audit inquiries within established deadlines.
• Conduct routine documentation reviews to verify that nursing notes, assessments, supervisory visits, physician orders, and Plans of Care support ongoing medical necessity and reimbursement.
• Identify documentation deficiencies and work directly with nursing staff and providers to obtain corrections prior to claim submission or audit review.
• Monitor payer policy updates, Medicare Conditions of Participation, Medicaid regulations, and managed care requirements, ensuring agency compliance with reimbursement guidelines.
• Develop and maintain reports tracking authorization status, pending renewals, audit requests, denials, appeals, and reimbursement trends.
• Participate in Quality Assurance (QA/QAPI) meetings by identifying documentation trends, authorization issues, denial patterns, and opportunities for process improvement.
• Educate clinical staff on documentation standards that support medical necessity, reimbursement, recertification, and regulatory compliance.
• Collaborate with Billing, Compliance, Clinical Operations, Intake, Scheduling, and Physician Offices to facilitate efficient authorization and reimbursement workflows.
• Assist with payer appeals by gathering supporting documentation, preparing appeal packets, and coordinating physician involvement when necessary.
• Ensure all documentation complies with Medicare, Medicaid, payer-specific, state, federal, accreditation, and agency requirements

• Manage on-call schedules and review on-call logs to ensure appropriate coverage and follow-up for NY and CT pediatric cases
• Collaborate with interdisciplinary teams (scheduling, compliance, HR) to ensure continuity of care and operational efficiency
• Coordinate and schedule nursing staff for orientation, ensuring all required competencies and training requirements are completed in accordance with agency standards
• Monitor and address nursing-related issues during off-hours through email and remote communication to ensure continuity of operations
• Provide coverage support for staffing gaps, ensuring uninterrupted patient care services
• Manage a designated caseload of Pediatric clients, ensuring a high level of service quality and client satisfaction
• Participate in and support the initiation (start of care) for VIP and high-acuity/high-tech pediatric cases as needed
• Assist with performance management, including disciplinary actions and corrective measures for Pediatric nursing staff in collaboration with leadership
• Serve as an advocate for Pediatric nursing staff, promoting team cohesion, engagement, and a positive work environment
• Perform additional duties and responsibilities as assigned to support clinical operations and organizational goals

• Generous PTO
• Health, dental, and vision insurance
• 401(k) with company match

• Leadership development opportunities
• Advancement within a growing organization

• Collaborative, team-oriented environment
• A company committed to excellence, compassion, and quality care

Powered by JazzHR