Job Description

Evaluates patients referred to the Organization; identifies insurance coverage, negotiates payment or per diem rates; plans and coordinates referrals for hospice services.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

1. Evaluates hospitalized patients referred for home care.

2. Attains a completed copy of the patient’s history and physical

3. Identifies and verifies insurance coverage of home health care services.

4. Obtains and documents prior authorization for home care services from insurance providers.

5. Assists in obtaining supplemental managed care orders under the direction of the HMO Intake Manager.

6. Negotiates per diem or per visit payment rates for creative bundling of home care services.

7. Collaborates with the hospital's discharge planning personnel, utilization review department and insurance Case Managers to facilitate safe, early discharge.

8. Consults with physicians, nurses, social workers, discharge planners and other disciplines to establish a coordinated home plan of care.

9. Verifies the completion of a Face to Face.

10. Interviews the patient, family, and caregiver and discusses the home situation, current needs, and any psychosocial factors that are relevant to the plan of care.

11. Completes referral information that includes intake data, essential background information, hospital course, and the plan of care.

12. Maintains liaison relationship with hospital and insurance personnel, providing information and education on Organization services, coverage issues and related areas.

13. Participates in patient care conferences and in-services.

14. Collects and maintains statistical data on all referrals and submits them regularly as required.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job related tasks other than those stated in this description.

Qualifications

1. Maintains a current Licensed Practical Nurse or Licensed Vocational Nurse to practice nursing in the state.
2. Graduate of an accredited practical nurse or vocational nursing program.
3. Maintains a current CPR certification.
4. Minimum of two years of experience working in home health care, hospice, or managed care preferred.
5. Demonstrates an ability to work with other health care clinicians, development of home plan of care, knowledge of third party reimbursement, and ability to negotiate payment rates.
6. Self-directed and able to work with minimal supervision.
7. Demonstrate excellent observation verbal and written communication skills.
8. Participation in Quality Assurance/Performance Improvement Program and Bridge Hospice sponsored training.

Additional Information

Here at Bridge Home Health and Hospice, we are committed to our employees and their well-being. Benefits Include:

• Competitive compensation
• Dynamic, fun, team-oriented work environment
• Countless growth and development opportunities
• Flexible Schedules
• Medical, dental and vision insurance
• Company Paid Life insurance
• Mileage Reimbursement 
• PTO
• Paid Holidays
• Paid Sick Days
• Employee Assistance Program
• 401K
• FSA

And so much more!