Home Health Utilization RN - Care Coordination

Family Health Center of Worcester, Inc.; Worcester, Northern (MA, KY); Hybrid; USD 4,890,000 - 6,130,000; Full time

Job summary

Family Health Center of Worcester, Inc. is seeking a Home Health Registered Nurse to join the Primary Care Team in Worcester, MA. This full-time position coordinates home health, quality improvement, and utilization review for center patients, ensuring timely, appropriate care and documentation.

The role requires MA RN licensure and a Bachelor’s degree in nursing; BLS is required. Experience in home health and discharge planning is preferred, with focus on patient-centered care and collaboration

Qualifications

• Bachelor's degree in nursing is required.
• Massachusetts RN licensure (Board of Registration) is required; BLS is required.
• Home health experience and knowledge of home health line services are preferred.
• Discharge planning and utilization review experience is desirable.

Responsibilities

• Coordinate home health, quality improvement, and utilization review for patients.
• Communicate determinations to providers and home care agencies per policy.
• Review home health communications and document as needed.
• Assist with DME requests and conduct clinical reviews for medical necessity.
• Refer non-qualifying cases for provider review and ensure timely processing.
• Maintain timely communications with PCP and practice team.
• Serve as liaison between agencies, members, families, and Health Center.
• Authorize services and coordinate care per standards, seeking supplements when needed.
• Participate in monthly meetings with home health agencies and ACO.
• Refer high risk cases to Care Management or community services.
• Integrate QI strategies to improve care processes and outcomes.
• Support patient-centered and culturally sensitive care in all activities.

Skills

Home health experience

Utilization review

Discharge planning

Education

Bachelor's degree in nursing

Master’s degree in nursing or Public Health preferred

RN licensed by MA State Board

BLS certification

Job description

Family Health Center of Worcester, Inc. is seeking a Home Health Registered Nurse to join the Primary Care Team in Worcester, MA. This full-time position coordinates home health, quality improvement, and utilization review for center patients, ensuring timely, appropriate care and documentation.

The role requires MA RN licensure and a Bachelor’s degree in nursing; BLS is required. Experience in home health and discharge planning is preferred, with focus on patient-centered care and collaboration