Buscar empleo: 49 ofertas de trabajo de appeals nurse en Paterson, New Jersey (agosto 2026)

Clinical Executive Director

hace 1 mes

Rochelle Park

Job DescriptionClinical Executive Director – Pediatrics (RN) Location: Rochelle Park, NJ Travel Required: New York (Manhattan & Long Island) and Connecticut Offices Salary: $120,000–$130,000 annually (Based on experience)Join Our Growing Pediatric Division! Affirmed Home Care, a premier concierge private-pay home care agency, is expanding our Pediatric Division and is seeking an experienced, dynamic, and motivated Clinical Executive Director (RN) to lead pediatric clinical operations across New Jersey, New York, and Connecticut. This is an exciting opportunity to join our leadership team and help shape one of the region's premier pediatric home care programs. The ideal candidate is an experienced Registered Nurse leader who is passionate about pediatric home care, operational excellence, quality outcomes, and developing high-performing clinical teams. This position is based in Rochelle Park, New Jersey, with regular travel to our Manhattan, Long Island, and Connecticut offices to provide clinical leadership, operational oversight, staff development, and support continued growth throughout the Pediatric Division. The Clinical Executive Director will oversee pediatric clinical operations, supervise skilled nursing teams, manage high-acuity and VIP pediatric cases, ensure regulatory compliance, and partner with leadership to deliver exceptional patient and family-centered care. Requirements • 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 Key Responsibilities Clinical Leadership & Team Oversight • 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 Clinical Operations & Case Management • 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. Documentation & Regulatory Compliance • 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 Quality Assurance & Performance Improvement (QAPI) • 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 Education & Staff Development • 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 Reimbursement, Authorizations & Clinical Documentation Responsibilities • 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 Operational Oversight • 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 Why Join Affirmed Home Care? Competitive Compensation $120,000 – $130,000 annually (Compensation based on experience) Comprehensive Benefits • Generous PTO, • Health, dental, and vision insurance, • 401(k) with company match Career Growth • Leadership development opportunities, • Advancement within a growing organization Supportive Culture • Collaborative, team-oriented environment, • A company committed to excellence, compassion, and quality care Apply Today Ready to take the next step in your nursing leadership career? Submit your resume today and join a company that values professional growth, clinical excellence, and compassionate care. Affirmed Home Care is an Equal Opportunity Employer. Powered by JazzHR KeLwMMHkeR

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