Intake RN - Tufts Medicine Care at Home : Job Details

Job Overview

Serves as a resource for referral sources and the publicregardingservices provided, third party regulations, determination of home care eligibility, and appropriateness for home care.Providesresource information if patient/client is not eligible or notappropriate forhome care.

Hours: Full Time 40 Hours

Location: Lowell, MA

Job Description

Minimum Qualifications:

1.Massachusetts RN Licensure and NH Licensure.

2.Two (2) years ofvisiting nurse experience.

Duties and Responsibilities:Theduties and responsibilities listedbeloware intended to describe the general nature of workandare not intended to be an all-inclusive list.Other dutiesand responsibilitiesmay be assigned.

• Obtains the necessary patient identification, medical and financial information required for the nurse and/or therapist to make theinitialhome health visit.

• Documentsimportant informationon the agency's “Request for Service” form creates a case inForcuraand the current EMR.

• Attempts to assess if the potential patient can manage safely in their home andassistsreferral source in making decisionsregardingsafe discharge planning.

• Assesses if the patient is eligible for home health services under their payment source.Try toestablishHome 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 withotherRNsas needed. Communicates the mission of the agencyto provide care for patients regardless of ability topay, andmanages expectations about the available services.

• Providesinformation 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.

• Identifiespre-admit evaluated patients and works todeterminehome care eligibility and appropriateness for home care.Communicates with department manager todetermineacceptance of referral.

• Follows referral department guidelinesregardingordersrequiredtoinitiatehome 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 informationis desirable vsnecessary.

• Uses critical thinking and problem-solving skills to resolve referral issues limiting the need to involve the referral source.

• Utilizesclinical judgment todetermineoptimalservices to manage a patient safely in the home setting.

• Adheres to referral order documentation guidelines developed to guide agency initiatives.

• Maintainsproductivity standards as defined by the department standards.

• Obtains prior authorizations and pre-certifications as required by insurer.

• Completes e-tracking andForcuracase final verification to inform clinical departments on admission state,diagnosesand 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 ofthird-partyregulations and insurance companies and HMO's.

• Identifiesopportunities to generate potential referrals for all agency services to meet the care needs of the patient.

• Demonstratesrequired knowledge of Home Health Foundation services for which a patient may be eligible.

• Selects the correct referral sources in the referral source tab to enableaccuratedata collection.

• Keeps department Clinical Lead informed of issues related to workflow.

• Reaches out tootherRNsand/or Intake Clinical Manager todetermineif a referral is to be accepted or declined.

• Reports Complianceconcerns tothe CEO or Chief Compliance Officer when applicable.

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation by emailing us [email protected].