Job: RN-Lead Home Care Coordinator-1.0-Days

RN-Lead Home Care Coordinator-1.0-Days

Requisition Number: 28859

Location: NM - Albuquerque

Type of Opportunity: Regular Full-Time

FLSA Classification: EXEMPT

Minimum Experience: 5 years

Minimum Education: Bachelors Degree

Shift: Days

Summary of Primary Functions

* Receives incoming calls from all sources and transcribes the necessary information to process a referral for transmission to the clinical team for scheduling of the admission assessment of the patient.

* Develops and maintains a working knowledge of all service and resources available within the company and the community.

* Enters the necessary demographic information to process the referral and admission of the patient into the computer system.

* Accurately obtains and transcribes initial orders for home care services and ensures follow up with any requests or orders.

* Makes recommendations for referral to alternate and appropriate inpatient, outpatient and/or community resources when Homecare is not appropriate.

* Identifies all potential payer sources and establishes the primary payer. Provides patient care representatives with patient payor information for verification. Completes initial authorization in a timely manner, as necessary.

* Ensures accurate insurance verification information is entered into the computer.

* Negotiates fees with commercial insurance companies to cover needed home care/hospice services and support the financial goals of the PHH organization.

* Arranges for DME and medical supplies as needed.

* Initiates pharmaceutical orders on all home infusion cases, as appropriate.

* Meets internal and external customer service expectations.

* Oversees referral information is maintained on appropriate logs.

* May be responsible for obtaining physician information necessary to maintain accurate records for each referring physician.

* Assumes responsibility for professional growth and development.

* Participates in Quality Assessment and Improvement activities and supports participation of all appropriate staff.

* Organizes materials on specialty services, clinical protocols, contracts, community services, alternative funding and key referral sources for PHHC staff.

* Identifies and resolves issues that affect Intake department to improve efficiencies. Communicates issues and plan to Director of Program Development on a regular basis.

* Increases and maintains referral base to PHH by ensuring effective operation of Intake Department including timeliness and accuracy of referral.

* Ensures a high level of performance of Intake staff.

* Communicates regularly with Director of Program Development, Director of Home Healthcare, and Director of Finance regarding Intake issues and needs that will impact the referral process of PHH. Assists with identifying new product lines through analysis of referral information.

* Responsible for coordination of department orientation for new staff.

* Responsible for scheduling of staff.

* Performs other duties as assigned

Graduate of an accredited School of Nursing and Bachelor's Degree in Nursing. At least 5 years clinical experience is required. Knowledge of utilization management, principles, HCFA guidelines, home healthcare, skilled nursing, facility/long term care and durable medical equipment is highly desirable. NM RN license required.