Home Care Liaison - Site

Advocate Health Care; Park Ridge (IL); On-site; USD 65,000 - 90,000; Full time

Job summary

Advocate Health Care is seeking a Registered Nurse to screen referrals and initiate home health services across programs, verifying benefits and obtaining authorizations while ensuring compliance with Medicare and state regulations.

You will interview patients in hospital or SNF, educate families, document care plans, coordinate with care management, and respond to inquiries, with on-call rotations and occasional travel to referral sites.

Job description

Major Responsibilities
Responsible for the screening and accurate completion of referrals to ensure patients meet agency admission criteria and comply with state and federal regulations.

• Processes referrals for all programs (Traditional, Peds, and Infusion Therapy) from hospital sites, MD offices, utilizing standard work and determines whether patient qualifies for home care based on established guidelines.
• Verifies home health care benefits according to payor plans. Obtains authorizations for services as indicated.
• Ensure physicians initial home care orders are obtained.
• Identifies risk management situations and completes high risk referral process on all appropriate patients based on established guidelines.
• Interprets company services, admission criteria and medical policies to referral sources and individuals seeking information.
• Documents the initial plan of home health care and initiates interdisciplinary communication.
• Interviews patients/families in the hospital or SNF, to assess and evaluate patient for home care appropriateness.
• Works in conjunction with the care management staff to assist the patient/family in the initiation of home care services. Responds to inquiries regarding home care services.
• Works within established productivity guidelines for assigned site(s). Reports productivity to supervisor daily.
• Trains patient/families in using equipment (e.g. pump) at home.

Major Responsibilities
Responsible for the screening and accurate completion of referrals to ensure patients meet agency admission criteria and comply with state and federal regulations.

• Processes referrals for all programs (Traditional, Peds, and Infusion Therapy) from hospital sites, MD offices, utilizing standard work and determines whether patient qualifies for home care based on established guidelines.
• Verifies home health care benefits according to payor plans. Obtains authorizations for services as indicated.
• Ensure physicians initial home care orders are obtained.
• Identifies risk management situations and completes high risk referral process on all appropriate patients based on established guidelines.
• Interprets company services, admission criteria and medical policies to referral sources and individuals seeking information.
• Documents the initial plan of home health care and initiates interdisciplinary communication.
• Interviews patients/families in the hospital or SNF, to assess and evaluate patient for home care appropriateness.
• Works in conjunction with the care management staff to assist the patient/family in the initiation of home care services. Responds to inquiries regarding home care services.
• Works within established productivity guidelines for assigned site(s). Reports productivity to supervisor daily.
• Trains patient/families in using equipment (e.g. pump) at home.

Provide quality customer service; promote collaboration/coordination between referral sources and home care services to promote continuity of care and utilization of home care resources effectively.

• Acts as a resource to physicians, physician offices, patients and families, hospital and designated skilled nursing facility staff (i.e. care management, discharge planners, social workers, nursing) regarding types of services available and the criteria for home care, including Medicare guidelines.
• Provides education to the care team as requested on services that may enhance the transition of care for patients including DME, Hospice, Palliative Care, Pediatrics and Home Infusion Therapy.
• Maintains knowledge of Medicare, Medicaid and HMO procedures.
• Attends site based multidisciplinary meetings (e.g. readmissions, capture, discharge planning) that involve Advocate at Home patients.
• Assures appropriate follow-up to patient satisfaction issues relating to home care services.
• Provide courteous service to patients, families, staff, and physicians.

Accountable for insuring complete referral information is obtained for accurate and timely billing.

• Maintains knowledge of agency payers including Medicare, Medicaid and contracted commercial insurance reimbursement guidelines.
• Collaborate with insurance verification to insure optimal reimbursement.
• Assists in the development of policies and procedures to ensure compliance with current practice standards.
• Obtain Face-to-Face (F2F) encounter form for all Medicare, Medicaid and Medicaid pending patients during referral process or within first 7 days.
• Educates physicians in the Face to Face process.

Teamwork

• Maintains own clinical skills and competency by attending monthly training and interdisciplinary team meetings.
• Provide suggestions or improvements in current practices (i.e. process, documentation, etc.) to improve quality, productivity and customer satisfaction.
• Provide a positive attitude for Advocate at home through self-management.
• Provide input regarding performance and compliance to standards of peers.
• Adapt to changing business needs, conditions and work responsibilities.
• Partner with peers to ensure productivity levels are achieved.
• Follow standard operating procedures and guidelines during referral processing to insure consistent messaging and superior customer service is provided.
• Participate in precepting new hire training and orientation.
• Partner with your peers and other Advocate at Home product lines to provide complete and thorough patient hand-offs when appropriate. Licensure: Nurse, Registered (RN) Education/Experience Required: RN with 3-4 years’ experience

1-2 years in home care preferred Knowledge, Skills & Abilities Required: Very good communication skills.

Knowledge of Medicare rules and regulations.

Experience in multi-tasking on multiple computer systems.

Strong customer service skills.

Working knowledge of managed care environment.

Critical thinking skills. Current RN licensure

Physical Requirements And Working Conditions
On call and weekend rotation
Ability to work in a fast paced environment
Ability to drive to referral sites in all weather conditions and to corporate office for meetings and training/education
If position has direct patient care or direct patient contact the following lifting requirement supersedes any previous lifting requirement effective 06/01/2015.
Ability to lift up to 35 pounds without assistance. For patient lifts of over 35 pounds, or when patient is unable to assist with the lift, patient handling equipment is expected to be used, with at least one other associate, when available. Unique patient lifting/movement situations will be assessed on a case-by-case basis. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.