Lead Clinical Access - Blue Ridge Care : Job Details

Overview

Lead Clinical Access Specialist-RN/LPN-180825 Blue Ridge Care

Join to apply for the Lead Clinical Access Specialist-RN/LPN-180825 role at Blue Ridge Care

Base pay range: $70,000.00/yr - $85,000.00/yr

Be the First Step in Exceptional Patient Care Lead Clinical Access Specialist Wanted

About Blue Ridge Care Services

Blue Ridge Care works to optimize the quality of life and well being for those members of our community affected by aging or dealing with chronic or serious illnesses. With a mission of brightening lifes journey for all whom we are privileged to serve, and a strategic goal to grow and expand our services to continue meeting the evolving healthcare needs of the community, Blue Ridge is Caring for life.

Our core values dignity, integrity, teamwork, innovation, diversity, and excellence reflect our commitment to our patients and families and to fostering a diverse and inclusive workplace culture that encourages staff to embrace creativity, work together, practice empathy and compassion, and utilize professional growth opportunities. At Blue Ridge, we call our staff Future Makers everyone contributes to our organizational excellence and success, and the continued delivery of life-changing care and services.

Responsibilities

The Lead Clinical Access Specialist oversees a team of Access Specialists and manages all aspects of referrals from hospitals, physicians, facilities, and individuals for Blue Ridge Cares service lines. The Lead ensures scheduling of initial visits, informational visits, and referrals are timely and for the appropriate service line. The role ensures compliance with federal, state, and local laws and regulations as well as The Joint Commission standards and the organizations policies and procedures. The Lead supports a seamless transition from referral to admission by verifying hospice eligibility, reviewing clinical documentation, collaborating with appropriate teams, and adhering to the Perfect Phone Encounter structure.

• Possesses interpersonal skills that promote collaboration and effective communication.
• Demonstrates working proficiency in Medicare, Medicaid, and other payor operations, in collaboration with the billing department, to support accounts receivable management.
• Conducts insurance verification and coordinates benefits for referrals to Blue Ridge Care service lines, with the business office serving as backup.
• Demonstrates strong data collection and analysis skills.
• Act independently and responsibly in consistently performing job duties.
• Exhibits a team-oriented mindset, flexibility, willingness to learn, strong interpersonal skills, and a customer service orientation.
• Demonstrates a commitment to delivering high-quality patient care.
• Assists in communication with patients, referral sources, and external providers.
• Prioritize patient needs by triaging based on acuity to ensure timely access for critical patients.
• Collaborates with providers regarding patient eligibility per Medicare guidelines and coordinates appropriate Face to Face assessments with providers.
• Arranges necessary medical supplies for patients transitioning from hospital or skilled services to ensure availability at the time of admission.
• Assist providers in obtaining infusion medications from pharmacies before admission.
• Serves as a resource for intake staff, offering guidance on diagnoses and treatments that require provider review prior to scheduling an admission.
• Provides administrative supervision to Access Center administrative volunteers.
• Respects the autonomy and confidentiality rights of all patients.
• Willing to travel throughout the entire service area.
• Seeks opportunities for professional growth, including demonstrating the ability to receive and apply constructive performance feedback. Engage supervisors or other resources to address areas for improvement.
• Participate in departmental and/or agency-wide quality improvement activities.
• Supports and upholds the mission of Blue Ridge Care.
• Performs other duties as assigned.

Lead Clinical Access Specialist Responsibilities

• Supports the Blue Ridge Perfect Phone Encounter structure.
• Collects data and documentation to assist in validating palliative and hospice eligibility.
• Facilitates a smooth transition from referral to admission when eligibility criteria are met.
• Verifies that all documentation required for admission, including insurance verification, is complete.
• Maintains clear and timely communication with all appropriate team members.
• Demonstrates proficiency in the Perfect Phone Encounter and communicates effectively with patients, families, physicians, referral sources, and staff.
• Completes benefit checks through the approved CMS website to verify coverage and obtain pre-authorization for services as needed.
• Initiates the Electronic Medical Record (EMR) at the time of referral by entering patient information and ensuring all necessary documentation is completed.
• Schedules for providers and other team members as appropriate.
• Assists with retrieving medical records and ensures all required documents are complete for admission.
• Files and maintains medical records in accordance with company policy and state/federal regulations.
• Assist in data collection and evaluation for quality outcomes and patient experience.

Education and Experience

• Registered Nurse or Licensed Practical Nurse (LPN) preferred.
• Hospice, Palliative, Home Health or Long-term care experience preferred.
• Must have reliable transportation and a valid drivers license.
• Strong public relations and interpersonal skills, with a professional telephone manner.
• Highly organized, flexible, and detail oriented.
• Proficient computer skills required; experience with Excel, Microsoft Office, and electronic medical records preferred.

Benefits

• Health Insurance
• Dental Insurance
• Vision Insurance
• Retirement with Company Match
• Paid Time Off
• Paid Volunteer Time
• Thrift Shop Discount

Blue Ridge Care is a non-profit, equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees and patients served.

Seniority level

• Entry level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care

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