Job Number: 20016449
Location: Brentwood, TN
Date Posted: 6-17-2017
Job Title: Home Health Care Coordinator
naviHealth is the result of over a decade of dedicated visionary leaders and innovative organizations challenging the status quo for PAC management solutions. We do healthcare differently and we are changing healthcare one patient at a time. How might you ask? By hiring talented clinicians, engineers, analysts, and healthcare leaders to create and utilize cutting edge technology to provide the patient with the best level of care for the right amount of time.
Why is this role critical...
The Home Health Care Coordinator (HHCC) role is to facilitate care coordination and information with member’s home care provider(s). Authorizes and approves extension of services for all members that have home health services according to CMS and national recognized guidelines. Responsible for conducting Welcome Home Call for these members within 24 hours. This position is essential for the communication and approval of the member’s home care benefits as outlined in the health plan.
What you will be accountable for...
1. Reviews the census daily for home health referrals and anticipated discharges to home health
2. Communicates with SSC that member’s eligibility is verified in the system.
3. Accepts referrals for home health authorizations from naviHealth team members and health care providers.
4. Case manages all members that have home health services and completes the Welcome Home Call within one day of discharge to home setting.
5. Documents health care providers’ requests for authorization for services
6. Enters information timely and accurately data into designated care management applications.
7. Reviews LiveSafe scores from previous settings, if applicable.
8. Reviews member’s record for completeness. Assures that health care providers have signed physician orders for all requests for authorizations.
9. Request additional records from health care providers, if needed.
10. Conducts HRA+ upon admission into home health and at discharge.
11. Determines how many visits are authorized per nationally recognized guidelines. Reviews health care providers documentation of services performed to determine if services are covered.
12. Communicates with the Home Health providers and primary physician when additional services are identified.
13. Makes additional authorizations as indicated and enters into the case management system.
14. Sends authorization form to home health providers.
15. Any denial for authorizations or requests for authorization outside the guidelines are immediately sent to the Medical Director for review. (The clinical staff has the authority to approve services based on medical necessity according to approved clinical coverage criteria. If the decision is outside the scope of the CC clinical staff member’s authority or expertise or fails to meet medical necessity requirements, the case is referred to a Physician Reviewer for a determination.)
16. Notifies the health care provider of denials approved by the Medical Director.
17. Collaborates with all providers, member and member’s medical power of attorney to establish an optimal and individualized care plan.
18. Assist the member in meeting their short and long term goals.
19. Completes the NOMNC and coordinates with the SSC the processing of the NOMNC.
20. Completes the Transition of Care summaries and sends to the Health Plan.
21. Communicates with health care providers and member, naviHealth’s role and provides information on prevention of re-hospitalization.
22. Reviews monthly/quarterly reports, acute re-admissions, and other reports as needed to identify opportunities for improvement.
23. Keeps up to date on national recognized criteria Utilization Management and CMS home health regulations.
24. Attends naviHealth meetings as requested.
25. Adheres to organizational, departmental and regulatory policies and procedures.
26. Keeps up to date on NCQA and URAC standards of practice.
27. Promotes a positive attitude and work environment.
28. Performs all other duties as assigned.
What you will need to be successful...
Physical Demands/Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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