Job Description
Evaluates patients referred to the Organization; identifies insurance coverage, and coordinates referrals for home care services.
ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES
- EVALUATES HOSPITALIZED PATIENTS REFERRED FOR HOME CARE.
- ATTAINS A COMPLETED COPY OF THE PATIENT’S HISTORY AND PHYSICAL.
- IDENTIFIES AND VERIFIES INSURANCE COVERAGE OF HOME HEALTH CARE SERVICES.
- OBTAINS AND DOCUMENTS PRIOR AUTHORIZATION FOR HOME CARE SERVICES FROM INSURANCE PROVIDERS.
- ASSISTS IN OBTAINING SUPPLEMENTAL MANAGED CARE ORDERS UNDER THE DIRECTION OF THE HMO INTAKE MANAGER.
- NEGOTIATES PER DIEM OR PER VISIT PAYMENT RATES FOR CREATIVE BUNDLING OF HOME CARE SERVICES.
- COLLABORATES WITH THE HOSPITAL'S DISCHARGE PLANNING PERSONNEL, UTILIZATION REVIEW DEPARTMENT AND INSURANCE CASE MANAGERS TO FACILITATE SAFE, EARLY DISCHARGE.
- CONSULTS WITH PHYSICIANS, NURSES, SOCIAL WORKERS, DISCHARGE PLANNERS AND OTHER DISCIPLINES TO ESTABLISH A COORDINATED HOME PLAN OF CARE.
- VERIFIES THE COMPLETION OF A FACE TO FACE.
- 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.
- COMPLETES REFERRAL INFORMATION THAT INCLUDES INTAKE DATA, ESSENTIAL BACKGROUND INFORMATION, HOSPITAL COURSE, AND THE PLAN OF CARE.
- MAINTAINS LIAISON RELATIONSHIP WITH HOSPITAL AND INSURANCE PERSONNEL, PROVIDING INFORMATION AND EDUCATION ON ORGANIZATION SERVICES, COVERAGE ISSUES AND RELATED AREAS.
- PARTICIPATES IN PATIENT CARE CONFERENCES AND IN-SERVICES.
- COLLECTS AND MAINTAINS STATISTICAL DATA ON ALL REFERRALS AND SUBMITS THEM REGULARLY AS REQUIRED.
- ATTENDS MEETINGS AND PARTICIPATES ON COMMITTEES AS REQUIRED.
- INFORMS DIRECTOR OF PATIENT CARE SERVICES AND INTAKE SUPERVISOR OF ALL DELAYS IN CLINICAL CARE.
- PERFORMS OTHER DUTIES AS ASSIGNED BY THE ADMINISTRATOR, DIRECTOR OF PATIENT CARE SERVICES, DIRECTOR OF CONTRACT MANAGEMENT, AND HMO INTAKE SUPERVISOR.
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.