Weekend Intake RN

Tufts Medicine•Lowell, MA

1d•$42 - $47

About The Position

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 .

Requirements

Massachusetts RN Licensure and NH Licensure.
Two (2) years of visiting nurse experience.

Responsibilities

Obtains the necessary patient identification, medical and financial information required for the nurse and/or therapist to make the initial home health visit.
Documents important information on the agency’s “Request for Service” form creates a case in Forcura and the current EMR.
Attempts to assess if the potential patient can manage safely in their home and assists referral source in making decisions regarding safe discharge planning.
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.
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.
Provides information of other community resources to the referring party if needed and if patient does not meet home care criteria.
Communicates with billing to verify atypical insurances as requested by referral sources and to support UR and Clinical Staff.
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.
Follows referral department guidelines regarding orders to initiate home health services .
All physician orders/approvals are noted in the referral orders.
Prioritizes completion of referrals based on clinical priority, patient safety, and insurance precertification.
Effectively manage the time it takes to complete referrals by understanding what information is desirable vs necessary.
Uses critical thinking and problem - solving skills to resolve referral issues limiting the need to involve the referral source.
Utilizes clinical judgment to determine optimal services to manage a patient safely in the home setting.
Adheres to referral order documentation guidelines developed to guide agency initiatives.
Maintains productivity standards as defined by the department standards.
Obtains prior authorizations and pre-certifications as required by insurer .
Completes e-tracking and Forcura case final verification to inform clinical departments on admission state, diagnoses and priority of ordered care.
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.
Demonstrates required knowledge of Home Health Foundation services for which a patient may be eligible.
Selects the correct referral sources in the referral source tab to enable accurate data collection.
Keeps department Clinical Lead informed of issues related to workflow.
Reaches out to other RN s and/or Intake Clinical Manager to determine if a referral is to be accepted or declined.
Reports Compliance concerns to the CEO or Chief Compliance Officer when applicable.