Director of Clinical Operations (Home Health) National Home Health Services - 4.1 San Jose, CA Job Details Full-time $110,000 - $160,000 a year 17 hours ago Benefits Health insurance 401(k) Tuition reimbursement Flexible schedule Referral program Qualifications Home care experience Program management RN License Bachelor of Science Team development Clinical documentation Acute care experience Home health agency experience General management Full Job Description Company Overview National Home Health Services is a leading provider of in-home skilled nursing and therapy services across Northern California. Since 2009, the organization has expanded its reach to multiple regions, ensuring patients receive high-quality care close to their homes while offering meaningful career opportunities for healthcare professionals.

Job Title:

Director of Clinical Operations Status:

Full-time Specialty/Focus Area:

Clinical Operations & Intake — Home Health (HH) and Acute Care at Home (ACAH)

Classification:

Exempt Supervisor:

Director of Patient Care Services (DPCS)

Pay Grade:

DOE Department/Division:

Nursing/Clinical Operations Position Summary:

The purpose of this Director of Clinical Operations (DCO) position is to own the intake-to-start-of-care pipeline for both the Home Health (HH) and Acute Care at Home (ACAH) service lines, and to serve as the operational extension of the Director of Patient Care Services (DPCS) across capacity management, payer authorization, readmission reduction, and continuous regulatory readiness. Nothing in this specification restricts management's right to assign or reassign duties and responsibilities to this job at any time. This job description is not an all-inclusive list of essential functions for the job described, but rather a general description of some of the responsibilities necessary to carry out the duties of this position. This is a hybrid role that blends remote work with in-person responsibilities, including branch presence, referral-source and hospital partner meetings, and direct supervision of the intake team. The role demands strong clinical judgment, command of home health regulatory and payer requirements, the ability to lead a multidisciplinary team across branches and service lines, and exceptional timeliness in completing assigned duties. Because referral acceptance and ACAH census decisions are time-sensitive, this position requires availability for escalation outside standard business hours. Director of Clinical Operations (DCO) Under general direction of the Director of Patient Care Services (DPCS), the DCO plans, directs, coordinates, and evaluates the intake, referral management, and clinical operations functions for National Home Health Services (NHHS) across all branches and both the Home Health and Acute Care at Home service lines. The DCO is accountable for a single, standardized referral-to-start-of-care process; for matching referral volume to clinical capacity; for ensuring eligibility, authorization, and documentation requirements are satisfied before care begins; and for the agency's performance on acute care hospitalization and emergency department utilization outcomes. The DCO directly supervises the intake team, sets performance standards, and develops staff through coaching and documented evaluation. The position requires the frequent use of discretion, initiative, and independent judgment, and differs from other nursing management classes in the breadth of operational accountability spanning two distinct service lines with different regulatory, contractual, and clinical requirements. The DCO serves as the primary operational partner to the DPCS — preparing analysis, carrying assigned initiatives to completion, representing the department as delegated, and acting as designee in the DPCS's absence to the extent permitted by agency policy and California Home Health Agency licensing requirements. The DCO adheres to the American Nurses Association Scope and Standards of Practice for Nurse Administrators and to evidence-based practice guidelines.

Essential Responsibilities:

• Intake and Referral Management (Home Health and ACAH) ○ Directs the end-to-end referral workflow for both service lines — receipt, clinical screening, eligibility and benefit verification, acceptance or decline determination, staffing assignment, and start of care (SOC) — ensuring one standardized process is followed across all branches. ○ Establishes and enforces referral response and SOC timeliness standards consistent with 42 CFR § 484.55, which requires the initial assessment visit within 48 hours of referral, within 48 hours of the patient's return home, or on the physician- or allowed practitioner-ordered SOC date, and completion of the comprehensive assessment no later than five (5) calendar days after SOC. ○ Applies objective, documented admission criteria to determine whether a referral can be safely and appropriately accepted — including homebound status and skilled need for Medicare home health, and acuity, eligibility, and home-environment criteria. ○ Serves as the clinical decision-maker on complex, high-acuity, or borderline referrals; escalates to the DPCS when a referral falls outside established acceptance criteria or agency capability. ○ Maintains a same-day acknowledgment standard for all referral sources and ensures every acceptance or decline is communicated with a documented clinical rationale. ○ Monitors referral-to-SOC cycle time, acceptance and decline rates, decline reasons, missed SOC windows, and referral-source mix; reports trends and corrective actions to the DPCS on a weekly cadence. ○ Partners with business development to maintain relationships with hospital case managers, discharge planners, ACAH command center staff, physician offices, and payer partners including Kaiser Permanente; resolves service failures at the source.

• Acute Care at Home (ACAH) Program Operations ○ Oversees intake for the ACAH/hospital substitution service line, coordinating with the partnering hospital's command center on patient selection, admission handoff, daily census, and discharge planning. ○ Ensures ACAH staffing patterns and visit schedules meet contracted service requirements, including required in-person visit frequency, 24/7 clinical availability, and defined escalation response timeframes. ○ Directs escalation and de-escalation workflows, including the criteria and process for return to the acute facility, and ensures every escalation event is documented, reviewed, and trended. ○ Coordinates DME, infusion, laboratory, imaging, and remote patient monitoring logistics so the home environment is verified and ready before admission. ○ Maintains ACAH documentation, competency, and reporting standards as distinct from traditional home health, and prevents workflow drift between the two service lines. ○ Maintains current working knowledge of the CMS Acute Hospital Care at Home (AHCAH) waiver requirements — extended through 2030 under the Consolidated Appropriations Act, 2026 — and adapts agency workflows to program, contract, and regulatory changes.

• Readmission Reduction and Transitions of Care ○ Owns the agency's readmission-reduction program; sets measurable targets with the DPCS and reports performance against them monthly. ○ Implements risk stratification at intake to identify patients at elevated risk of rehospitalization and assigns front-loaded visit patterns, disease-specific pathways, and escalation plans accordingly. ○ Ensures medication reconciliation is completed at the initial visit and that identified discrepancies are communicated to the ordering practitioner and resolved. ○ Directs root cause review of every acute care hospitalization and emergency department visit, distinguishes preventable from non-preventable events, and converts findings into practice changes and targeted education in partnership with the Education Department. ○ Monitors OASIS-based outcome measures — Acute Care Hospitalization, Emergency Department Use without Hospitalization, Discharge to Community, and Timely Initiation of Care — along with Care Compare star ratings, and drives improvement plans where NHHS trails state and national benchmarks. ○ Ensures after-hours and on-call triage protocols are clear, followed, and escalate appropriately; audits on-call call logs and dispositions. ○ Oversees transition-of-care handoffs — hospital to home health, ACAH to home health, home health to hospice or community-based services — so that no patient is lost between service lines or levels of care.

• Capacity, Staffing, and Throughput ○ Maintains a live view of clinical capacity by discipline, geography, language, and payer, and matches incoming referral volume against it before acceptance. ○ Partners with clinical supervisors and scheduling to distribute caseloads equitably, minimize missed and unstaffed visits, and reduce referral turn-downs attributable to capacity rather than clinical appropriateness. ○ Monitors visit utilization against the plan of care and the PDGM 30-day period structure; manages LUPA exposure and over-utilization through proactive review rather than retrospective correction. ○ Escalates staffing gaps early to the DPCS with a quantified request — discipline, geography, hours, and the referral volume at risk. ○ Reviews productivity, visit mix, travel efficiency, and geographic assignment to improve throughput without compromising visit quality or clinician sustainability. ○ Partners with the Education Department to align onboarding pace and competency validation with anticipated capacity needs.

• Payer, Authorization, and Eligibility Management ○ Directs verification of eligibility, benefits, and authorization prior to SOC for all payers, including Medicare, Medicare Advantage, Kaiser Permanente, Medi-Cal, and commercial contracts. ○ Owns the authorization workflow end to end — initial, concurrent, and re-authorization — and ensures no care is delivered outside an active, documented authorization. ○ Ensures clinical documentation substantiates medical necessity, homebound status, skilled need, and the face-to-face encounter requirement before and throughout the episode. ○ Monitors Notice of Admission (NOA) submission timeliness against the CMS five (5) calendar day requirement, tracks late submissions and the resulting per-day payment reduction, and eliminates the root causes of delay. ○ Manages denials and appeals in coordination with billing and clinical leadership; tracks denial reasons by payer and closes the loop with process or documentation fixes. ○ Maintains current knowledge of payer contract terms, covered visit types, and payer-specific requirements; builds and updates job aids so the intake team applies them consistently.

• Quality, QAPI, and Regulatory Readiness ○ Serves as a standing member of the QAPI committee; brings intake, throughput, authorization, and readmission data to each meeting with analysis and recommendations. ○ Leads performance improvement projects tied to measurable outcomes, with defined baselines, interventions, and re-measurement. ○ Maintains continuous survey readiness for the Medicare Conditions of Participation (42 CFR Part 484), Joint Commission Home Care standards, and California Department of Public Health licensing requirements; participates in and helps lead mock surveys. ○ Audits intake and admission documentation for completeness and accuracy — physician and allowed practitioner orders, face-to-face encounter documentation, consents, homebound justification, and

OASIS SOC

timeliness — and coaches to correction. ○ Ensures corrective action plans arising from audits, complaints, or survey findings are completed, documented, and validated for sustained effect. ○ Reports adverse events, complaints, and grievances per agency policy and applicable regulatory requirements; participates in investigation and resolution.

• Leadership and Supervision ○ Directly supervises the intake team supporting both service lines — recruits, orients, schedules, coaches, evaluates, and manages performance including corrective action in partnership with Human Resources. ○ Sets clear, measurable productivity and quality expectations for each intake role; conducts regular one-on-ones and documented annual performance evaluations. ○ Builds cross-training and redundancy so intake coverage is uninterrupted during absence, turnover, and volume surges. ○ Chairs the daily or weekly intake and throughput huddle, ensuring pending referrals, unstaffed cases, authorization holds, and ACAH census are reviewed and assigned. ○ Models professional communication and a culture of safety, service excellence, and evidence-based practice.

• DPCS Support and Additional Responsibilities ○ Serves as the primary operational support to the DPCS — prepares data, briefings, and recommendations; carries assigned initiatives to completion; represents the DPCS in internal and external meetings as delegated. ○ Acts as the DPCS designee in the DPCS's absence to the extent permitted by agency policy and California Home Health Agency licensing requirements. ○ Maintains current knowledge of Medicare home health Conditions of Participation, current OASIS guidance, PDGM, hospital-at-home requirements, infection prevention, California licensing requirements, and agency policies and procedures. ○ Serves as a super-user and workflow owner in the agency EHR (e.g., WellSky) for intake, referral, and authorization functions; partners with IT on build, access, and reporting. ○ Develops and assists with the implementation of policies and procedures governing intake and clinical operations to assure improved compliance with all regulatory bodies and accrediting agencies for home health. ○ Performs other duties as assigned by the

DPCS. QUALIFICATIONS

Education Graduate of an accredited NLN nursing program. Bachelor of Science in Nursing (BSN) required. Master's degree (MSN, MHA, MBA, or related field) preferred, or currently enrolled in an advanced degree program. Certifications BLS — current and maintained. COQS — Certified OASIS Quality Specialist (or equivalent OASIS certification) within one (1) year of hire. Certification in home health/hospice nursing (e.g., ANCC, HCS-D, HCS-O) or healthcare leadership preferred. Experience Minimum five (5) years of progressively responsible clinical nursing experience, of which at least three (3) years are in home health. Minimum two (2) years in a supervisory, management, or director-level role with direct responsibility for staff performance. Demonstrated experience in intake/referral management, utilization or authorization management, and readmission reduction initiatives. Experience supporting a hospital-at-home, acute care at home, transitional care, or hospital substitution program strongly preferred. Working knowledge of the Medicare Conditions of Participation for Home Health (42 CFR Part 484), OASIS, PDGM, and Joint Commission Home Care standards. Demonstrated ability to build, interpret, and act on operational dashboards and clinical outcome data. Requirements Must possess a valid, current Registered Nurse (RN) license in the state of California, in good standing. Must possess a valid California driver's license, reliable transportation, and auto insurance meeting agency requirements. Must be able to read, write and speak the English language. Must possess the ability to make independent decisions when circumstances warrant such action. Have the ability to be tactful and polite with personnel, patients, family members, visitors, government agencies, and the public. Must possess leadership skills and the willingness to work harmoniously with all personnel. Must be able to move intermittently throughout the workday. Must be able to cope with the mental and emotional stress of the position. Must function independently, have flexibility, personal integrity, and the ability to work effectively with the interdisciplinary care team, the agency staff, and external entities. Must be able to work with ill, disabled, elderly, and at times emotionally upset people. Must be available by phone outside of standard business hours for escalations affecting patient safety, intake acceptance decisions, or ACAH census.

Work Environment:

Hybrid remote and office-based position with required attendance at scheduled in-office meetings, huddles, committee meetings, referral-source visits, and surveys. Must be able to meet deadlines timely and manage competing time-sensitive priorities across two service lines. Travel between branch offices and partner facilities as needed/required. Availability by phone outside standard business hours for escalations affecting patient safety, referral acceptance, or ACAH census.

Pay:

$110,000.00 - $160,000.00 per year

Benefits:

401(k) Flexible schedule Health insurance Referral program Tuition reimbursement

Work Location:

Hybrid remote in San Jose, CA 95134