Home Health Coordinator PRN
Home Health Coordinator PRN
Summary:
Interacts with third party payors, external case managers and employers to integrate payors with interdisciplinary team through case management process. Assesses patients for potential case management. Negotiates benefits and care plan between patient, team, family, and payor. Monitors effectiveness of plan and customer/third party payor satisfaction, serves as single contact point for customer. Upholds the standards of the system-wide customer service program.
Responsibilities:
Contributes to patient safety by:
a.Providing a safe environment for patients.
b.Reporting safety concerns, errors and near misses.
c.Participating in system improvement initiatives to prevent errors.
d.Providing evidence-based care as applicable to the role.
1.Serves as liaison with interdisciplinary team and payors (case managers, employers, third party payors) by:
a.Facilitating communication between the interdisciplinary team, patient, family, payor, Patient Accounts, and other departments as required.
b.Coordinating the flow of information regarding benefits, preferred providers, etc.
c.Integrating information regarding patient's needs between the interdisciplinary team and the payor source.
d.Acting as coordinator along with clinical case managers to facilitate payor and team goals for post hospital care needs (home health skilled care, infusion care, private duty, and other outpatient services).
e.Assuring the coordination of services.
2.Provides clinical expertise by:
a.Understanding treatment plans, goals, and objectives in relationship to payor issues.
b.Providing objective patient advocacy.
3.Establishes and maintains linkage to resources ‑ case managers, providers, payors, community services by:
a.Working with payors and providers to establish outcomes, goals, and objectives.
b.Communicating knowledge of insurance industry, negotiable parameters, and benefits criteria.
c.Communicating treatment plans and goals.
d.Providing necessary documentation to appropriate post hospital providers.
4.Serves as manager of resources regarding costs, benefits, and services by:
a.Providing expertise in cost/benefit analysis.
b.Accessing appropriate sources to fully investigate benefit/treatment options.
5.Responsible for program effectiveness; maintains follow‑up and process for evaluation by:
a.Monitoring outcomes of negotiated treatment plan.
b.Evaluating the quality of services provided and monitoring patient and payor satisfaction.
c.Monitoring increases in volumes of services.
6.Serves as Educator/Facilitator by:
a.Assisting patient/family and interdisciplinary team to understand payor/treatment issues.
b.Conducting patient/provider/payor education regarding alternative care delivery resources and other components of the discharge planning process.
c.Conducting patient education about case management and identifying opportunities for ongoing education.
7.Provides a link to referral sources and Commercial Development Department by:
a.Identifying opportunities for program enhancement and ongoing program development and expansion of services.
b.Constructing profiles of payors and referrals for both payors and internal use.
8.Displays sensitivity to and understanding of various cultural, ethnic, racial, and socioeconomic backgrounds.
9.Performs other functionally related duties as assigned.
Qualifications:
Required:
RN licensed in the State of Ohio Three years of hospital in-patient care or home care experience Able to work independently and as a member of interdisciplinary teams Effective written and oral communication and organizational skills Basic computer skills Ability to multitask
Preferred:
Two years of experience with case management, discharge planning, home-health and/or third party reimbursement systems Experience in specific clinical area desirable BSN Degree