Plan of Care Reviewer

American Addiction Centers•Oak Brook, IL

3d•$38 - $57•Hybrid

About The Position

This is a part-time PRN position for a Plan of Care Reviewer within the 39104 IL Home Health Divisional - Pre Billing Center. The role involves serving as a clinical coordinator for field staff, liaisons, physicians, admissions, and reimbursements. The reviewer will be the internal point person for new referrals and changes to treatment plans, assessing new patient care requirements, and obtaining physician orders. Collaboration with the Clinical Manager and participation in multi-disciplinary patient care conferences are key aspects of the role. Additionally, the position involves determining nursing care needs, assigning skilled nursing staff, coordinating services with subcontracted agencies, and providing feedback on field staff performance. The role also includes responsibilities in reimbursement and case management, such as assessing new patients for qualifying criteria and developing Plans of Treatment (POT).

Requirements

Registered Nurse
3 years combined adult med./surg. experience
2 years homecare experience as a RN.
Illinois RN License
CPR Accredited
Exceptional interpersonal skills--able to work well with diverse personality types in a fast paced environment --internal & external customers.
Strong knowledge of home care services
Good working knowledge of home care insurance benefits –Medicare (Part A & Part B), Medicaid, Managed Care
Must be willing to operate personal vehicle to conduct patient visits.
Ability to travel between AHHS branches and to client meetings in types of weather on all types of roads.
Required to be on-call (carry pager).
Good analytical skills
Excellent interpersonal/communication skills
Must be knowledgeable of regulatory home care guidelines and admission criteria
Ability to lift up to 100 pounds occasionally and in excess of 50 pounds frequently and/or in excess of 20 pounds constantly.
Ability to lift up to 35 pounds without assistance. For patient lifts of over 35 pounds, or when patient is unable to assist with the lift, patient handling equipment is expected to be used, with at least one other associate, when available. Unique patient lifting/movement situations will be assessed on a case-by-case basis.

Nice To Haves

Some introduction to intake coordination or care coordination with a homecare company preferred.

Responsibilities

Serves as clinical coordinator for field clinical staff, home care liaisons, physicians, admissions and reimbursements.
Serves as internal point person for new home care referrals, and changes or updates to existing treatment plans.
Assesses and determines new patient care requirements with home care liaisons prior to discharge from hospital as appropriate.
With home care team, determines most effective method to achieve patient treatment goals.
Obtains verbal orders from physicians when required for initial care or changes to care.
Communicates treatment orders and patient assessment information to field nurse assigned to case before SOC.
Triages office calls to assure resolution.
Collaborates with Clinical Manager regarding treatment provision and changes to plan of care.
Participates in multi-disciplinary patient care conferences as needed.
Determines nursing care needs for individual patients, then assigns and schedules appropriately skilled field nursing staff to meet those care needs.
Coordinates services and communicates authorizations and treatment protocols to subcontracted agency staff for both nursing and ancillary therapy needs as needed.
Provides feedback to nursing supervisors regarding field staff performance to be used when conducting performance evaluations.
Participates in “Manager On Call” rotation.
May provide case updates to external case managers –verbal or written reports, documentation copies, etc. as needed.
Assesses new patients for qualifying criteria -financial, appropriateness of care, patient safety. Assists admissions personnel and managers with alternatives when patients do not appropriately qualify.
May review and develop POT with field nurse and monitors tickler file to insure timely return from physician in concert with the Clinical Manager.
Practices MVP.
Demonstrates Advocate Health Care’s leadership competencies.
Encourages and sets expectations for staff to do the same.
Contributes “best thinking” to the organization, share experiences, education and insight with peers, associates and home care leadership.
Question/challenge the status-quo and suggest better ways of doing things.
Practices and creates an environment that supports and sustains effective communication with internal and external customers.
Develops and sustains relationships that enhances effective coordination of care and increases referral base.

Benefits

Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program