Clinical Referral Coordinator (RN/LPN) (10297)

Summit Home Care & Hospice•Grandview Heights, OH

2d•Hybrid

About The Position

Summit Home Care and Hospice is seeking an experienced and motivated Clinical Referral Coordinator to join their team. The company is dedicated to providing comprehensive healthcare services in patients' homes to enhance their quality of life. This role involves receiving, reviewing, and monitoring new referrals to determine the ability to accept or decline based on clinical appropriateness and anticipated homecare needs. The position is a day shift, Monday – Friday, 40 hours/week role, including a weekend/holiday rotation. It is located in Grandview Heights, OH, with the opportunity for remote work after 6 months.

Requirements

High school diploma required.
Active Ohio nursing license required (LPN or RN).
Must obtain an Indiana nursing license within 120 days (about 4 months) of employment.
Ability to work independently or as an active member of a team.
Strong computer skills in data entry, Microsoft Excel, and Word applications, must type 50 WPM.
Strong attention to detail and problem-solving skills.
Strong time management skills.
Excellent verbal and written communication skills.
Able to navigate multiple EMR systems (EPIC, Alis, Kinnser) for patient information with ease.
Ability to multitask, prioritize, delegate, and handle constant changes in workflow.

Responsibilities

Receive, review, and monitor new referrals to determine ability to accept or decline.
Accurately determine and anticipate homecare needs and accept and decline on clinical appropriateness.
Assists in interpreting operational indicators to detect census changes and increases or decreases in volume, which could impact staffing levels, revenues, or expenses.
Adheres to the agency’s Acceptance to Service Policy.
Collaborate with multiple teams, both internal and external, to ensure patient success in the homecare setting.
Demonstrate professional assertiveness when communicating with external referral resources.
Report and/or troubleshoots missing or incomplete documentation or visit notes needed for new admissions.
Works with Authorizations and clinical management team when new insurances are identified to determine reimbursement, ability to bill and if new contract is needed.
Call for, follow up on, track and obtain verbal orders for admissions.
Fax written orders for signature for admissions when verbal order unable to be obtained.
Ability to track, trend and maintain accept/decline reports.
Ability to identify primary and secondary billable diagnosis.
Understand and adhere to F2F requirement regulated by CMS.
Ability to maintain Pre-Claim Review (PCR) of no less than 97% (While participating in PCR as an agency).
Utilize office and other patient care software, including Microsoft Word, Excel, Adobe, and E- Fax.
Maintain confidentiality of information related to patient and organization.
Perform interdepartmental and external communication.
Engage in team meetings and provide feedback.
Develop and implement organization policies and procedures under guidance of supervisor(s).
Attend in-person training and meetings when necessary.
All other duties as assigned by supervisor(s).