Home Health Utilization Nurse: Quality & Care Coordination

ADP, Inc.; Worcester (MA); On-site; USD 101,612,000 - 127,511,000; Full time

Job summary

ADP, Inc. in Worcester, MA is seeking a Home Health Registered Nurse to join the Primary Care Team and coordinate home health, quality improvement, and utilization review improvements for center patients.

The Nurse conducts reviews to assess utilization, quality, and tenure of services for identified home health patients. The role involves collaboration with providers and home care agencies, documenting determinations, supporting care coordination, and participating in monthly meetings with

Qualifications

• Bachelor's degree in nursing required.
• RN licensure with Massachusetts State Board of Registration (BLS required).
• Home health experience and understanding of home health services.
• Discharge planning and utilization review experience preferred.

Responsibilities

• Coordinate home health, quality improvement and utilization review for center patients.
• Communicate determinations to providers and home care agencies in writing.
• Review home health agency communications and provide documentation as needed.
• Assist with DME requests.
• Conduct clinical reviews to determine medical necessity and eligibility.
• Refer cases not meeting criteria for Provider review to ensure timely processing.
• Maintain timely communications with PCP and practice team.

Skills

Nursing expertise

Communication skills

Utilization review

Education

Bachelor's degree in Nursing

Master’s degree in Nursing or Public Health (preferred)

Job description

ADP, Inc. in Worcester, MA is seeking a Home Health Registered Nurse to join the Primary Care Team and coordinate home health, quality improvement, and utilization review improvements for center patients.

The Nurse conducts reviews to assess utilization, quality, and tenure of services for identified home health patients. The role involves collaboration with providers and home care agencies, documenting determinations, supporting care coordination, and participating in monthly meetings with