Job Profile
Summary
This role focuses on performing activities associated with evaluating, developing, recommending, implementing, and carrying out the policies and procedures related to the delivery of
high quality
patient care
.
In addition, this role focuses on performing the following Care Navigation related duties
include:
Focuses on the patient‘s needs and helps guide the patient through the healthcare system and works to overcome obstacles that are in the way of the patient receiving the care and treatment they require
.
A professional individual contributor role that may direct the work of other
lower level
professionals or manage processes and programs
.
The majority of
time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically
acquired
through advanced education
.
An experienced level role that applies practical knowledge of job area typically obtained through advanced education and work experience
.
Works independently with general supervision, problems faced are difficult but typically not complex, and may influence others within the job area through explanation of facts,
policies
and practices.
Job Overview
Serves as a resource for referral sources and the public
regarding
services provided, third party regulations, determination of home care eligibility, and appropriateness for home care
.
Provides
resource information if patient/client is not eligible or not
appropriate for
home care
.
Job Description
Minimum Qualifications
:
1.
Candidates must hold an active RN license in the state where services are provided and may not work in states where they are not licensed. If additional state licensure is required, it must be obtained within sixty (60) days
2
.
Two (2) years of
visiting nurse experience.
Hours: Weekends Only. 8am-4:30pm
Location: Hybrid/Remote
Duties and Responsibilities
:
The
duties and responsibilities listed
below
are intended to describe the general nature of work
and
are not intended to be an all-inclusive list
.
Other duties
and responsibilities
may be assigned.
1.
Obtains the necessary patient identification, medical and financial information required for the nurse and/or therapist to make the
initial
home health visit.
2.
Documents
important information
on the agency’s “Request for Service” form creates a case in
Forcura
and the current EMR.
3.
Attempts to assess if the potential patient can manage safely in their home and
assists
referral source in making decisions
regarding
safe discharge planning.
4.
Assesses if the patient is eligible for home health services under their payment source
.
Try to
establish
Home Bound status and if medically necessary/reasonable requests.
5.
Effectively manages HHVNA and Hospice referrals for patients who do not have insurance coverage for requested services and consults with
other
RN
s
as needed. Communicates the mission of the agency
to provide care for patients regardless of ability to
pay, and
manages expectations about the available services.
6.
Provides
information of other community resources to the referring party if needed and if patient does not meet home care criteria.
7.
Communicates with billing to verify atypical insurances as requested by referral sources and to support UR and Clinical Staff.
8.
Identifies
pre-admit evaluated patients and works to
determine
home care eligibility and appropriateness for home care
.
Communicates with department manager to
determine
acceptance of referral.
9.
Follows referral department guidelines
regarding
orders
required
to
initiate
home health services
.
All physician orders/approvals are noted in the referral orders.
10.
Prioritizes completion of referrals based on clinical priority, patient safety, and insurance precertification.
11.
Effectively manage the time it takes to complete referrals by understanding what information
is desirable vs
necessary.
12.
Uses critical thinking and problem
-
solving skills to resolve referral issues limiting the need to involve the referral source.
13.
Utilizes
clinical judgment to
determine
optimal
services to manage a patient safely in the home setting.
14.
Adheres to referral order documentation guidelines developed to guide agency initiatives.
15.
Maintains
productivity standards as defined by the department standards.
16.
Obtains prior authorizations and pre-certifications as required by insurer
.
17.
Completes e-tracking and
Forcura
case final verification to inform clinical departments on admission state,
diagnoses
and priority of ordered care.
18.
Keep the Intake clinical manager informed of any problems communicated by referral sources.
Report any changes or trends noted in referral patterns to Department manager.
Keep abreast of
third-party
regulations and insurance companies and HMO’s.
Identifies
opportunities to generate potential referrals for all agency services to meet the care needs of the patient.
19.
Demonstrates
required knowledge of Home Health Foundation services for which a patient may be eligible.
20.
Selects the correct referral sources in the referral source tab to enable
accurate
data collection.
21.
Keeps department Clinical Lead informed of issues related to workflow.
22.
Reaches out to
other
RN
s
and/or Intake Clinical Manager to
determine
if a referral is to be accepted or declined.
23.
Reports Compliance
concerns to
the CEO or Chief Compliance Officer when applicable.
Physical Requirements
:
1.
F
requently
required
to move about inside the office to access
file
cabinets, office machinery, etc.
2. A
b
ility
to remain in a stationary position 90% of the time.
3. O
ccasionally lift
s
and/or
move
up to 10-25 pounds.
4.
Constantly
operates
a computer and other standard office equipment such as copy
machine
, phones,
photocopier
, fax machines and computer printers.
5
.
Specific vision abilities apply including close vision, distance vision and ability to adjust focus.
6. N
oise level in the work environment is usually moderate.
Skills & Abilities:
1
.
Ability to function well in
very busy
situations.
2
.
Responsible and reliable.
3
.
Good organization
al
skills.
At Tufts Medicine, we want every individual to feel valued for the skills and experience they bring. Our compensation philosophy is designed to offer fair, competitive pay that attracts, retains, and motivates highly talented individuals, while rewarding the important work you do every day.
The base pay ranges reflect the minimum qualifications for the role. Individual offers are determined using a comprehensive approach that considers relevant experience, certifications, education, skills, and internal equity to ensure compensation is fair, consistent, and aligned with our business goals.
Beyond base pay, Tufts Medicine provides a comprehensive Total Rewards package that supports your health, financial security, and career growth—one of the many ways we invest in you so you can thrive both at work and outside of it.
Pay Range :
$42.00 - $47.41