Plan of Care Reviewer

39104 IL Home Health Divisional - Pre Billing Center

Part time

No

0

PRN position

Pay Range:

$38.20 - $57.30

Major Responsibilities: ONGOING: Practices MVP. Demonstrates Advocate Health Care’s leadership competencies. Encourages and sets expectations for staff to do the same. ONGOING: 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. ONGOING: 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. Internal department Care & Treatment Coordination 1)Serves as clinical coordinator for field clinical staff, home care liaisons, physicians, admissions and reimbursements. 2)Serves as internal point person for new home care referrals, and changes or updates to existing treatment plans. 3)Assesses and determines new patient care requirements with home care liaisons prior to discharge from hospital as appropriate. 4)With home care team, determines most effective method to achieve patient treatment goals. 5)Obtains verbal orders from physicians when required for initial care or changes to care. 6)Communicates treatment orders and patient assessment information to field nurse assigned to case before SOC. 7)Triages office calls to assure resolution.. 8)Collaborates with Clinical Manager regarding treatment provision and changes to plan of care. 9)Participates in multi-disciplinary patient care conferences as needed. Staff & Patient Care Management 1)Determines nursing care needs for individual patients, then assigns and schedules appropriately skilled field nursing staff to meet those care needs. 2)Coordinates services and communicates authorizations and treatment protocols to subcontracted agency staff for both nursing and ancillary therapy needs as needed. 3)Provides feedback to nursing supervisors regarding field staff performance to be used when conducting performance evaluations. 4)Participates in “Manager On Call” rotation. Reimbursement & Case Management 1)May provide case updates to external case managers –verbal or written reports, documentation copies, etc. as needed. 2)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. 3)May review and develop POT with field nurse and monitors tickler file to insure timely return from physician in concert with the Clinical Manager. Other Duties as assigned. Licensure: Nurse, Registered (RN) Education/Experience Required: • Registered Nurse • 3 years combined adult med./surg. experience • 2 years homecare experience as a RN. • Some introduction to intake coordination or care coordination with a homecare company preferred. Knowledge, Skills & Abilities Required: • 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 • Illinois RN License • CPR Accredited Physical Requirements and Working Conditions: 1. Must participate in Manager “on call” rotation. 2. Must be willing to operate personal vehicle to conduct patient visits. 3. Ability to travel between AHHS branches and to client meetings in types of weather on all types of roads. 4. Required to be on-call (carry pager). 5. Good analytical skills 6. Excellent interpersonal/communication skills 7. Must be knowledgeable of regulatory home care guidelines and admission criteria 8. Ability to lift up to 100 pounds occasionally and in excess of 50 pounds frequently and/or in excess of 20 pounds constantly. If position has direct patient care or direct patient contact the following lifting requirement supersedes any previous lifting requirement effective 06/01/2015. 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. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• 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

Benefits and more

• 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

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.