Responsible for coordination of patient care and services in the areas of audit and compliance; visit authorization, complex case management and customer service. Completes medication review of all patients with therapy only services. Supports field operations by assisting clinicians with communication and relay of information between disciplines, physicians and vendors to obtain necessary orders and supplies for patient care. Demonstrates knowledge of the State Nurse Practice Act, agency policies and procedures, Medicare Conditions of Participation, and professional home care standards. Reviews clinical record and documentation within the context of care coordination.

ACCOUNTABILITIES

1. Completes review of comprehensive assessment and discusses concerns with care team.

2. Incorporates disease management strategies to improve patient outcomes. Utilizes the nursing process as a framework for the delivery of care. Demonstrates ability to systematically assess situation and triage appropriately.

3. Provides initial and ongoing reports to insurance companies and managed care vendors to obtain visit authorization. Obtains orders from the physician for care extensions or prn visits. Monitors visit utilization for assigned caseload and identifies areas of concern and completes appropriate follow-up with the team.

4. Supports field operations by assisting clinicians with communication and relay of information between disciplines, physicians and vendors to obtain necessary orders and supplies for patient care.

5. Participates in unit meetings, taskforce activities, and quality improvement activities. Pursues educational opportunities to enhance competencies, knowledge base and skills.

6. Participates in on-call/weekend/holiday responsibility as requested.

7. Performs other duties

In return for your expertise, you’ll enjoy excellent training, industry-leading benefits and unlimited opportunities to learn and grow. Be a part of the team leading the nation in healthcare.

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REQUIRED QUALIFICATIONS

Education: Associate's degree.

Skills: BLS, Working knowledge of Microsoft office products

Years of Experience: 1 year recent acute care clinical

License: Licenses RN in state of Ohio, Michigan, or both depending on service area.

PREFERRED QUALIFICATIONS

Education: Bachelor’s degree preferred.

Skills: Previous experience with a computer documentation system

Years of Experience: 1 year home care or case management

ADDITIONAL EXPERIENCE

Must have excellent organizational and problem solving skills. Must be a team player, flexible and able to handle multiple tasks at one. Strong customer and effective interpersonal skills required.