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Weekend Homecare Utilization Assistant, VNA of Cape Cod
4 months ago
* Work closely with the Clinical Team Managers and the Home Care Utilization Navigator in the following:
a. Ensure all clinicians on team consistently meet productivity expectations.
b. Visit utilization/coordination of patient-centered care.
c. Coordination/scheduling of IDTs.
2. Review initial admission information to provide required clinical documentation to
providers for authorization, utilization, and payment.
* Tracking of medical documents for commercial insurances and Medicaid to ensure patient schedules and authorizations are compatible.
* Continually provides managed care organizations with clinical documentation to comply with payer' requirements to obtain reimbursement.
* Follows through in a timely manner to request/obtain service authorizations per the insurance defined procedures.
* Processes reconsiderations and appeals of denials for service as appropriate. Review ongoing retroactive reimbursement issues.
* Maintains updated managed care/reimbursement manuals.
* Interprets agency policies and criteria for service to insurers, fiscal intermediaries, patients/families, physicians, and the public.
* Ensure compliance of home health aide (HHA) supervisions when HHAs are referred on certified home care patients.
* Ordering of supplies for patients/field staff.
* Organizes and monitors skills checklist of clinicians on team.
* Maintain knowledge of JCAHO and DPH regulations as well as agency policies and procedures.
* Communication with patients to discuss and collaborate schedule of certified nursing, therapy, and medical social work visits.
* Notifies client/family of schedule changes.
* Scheduling of all clinicians in the team to ensure they meet their daily productivity expectations.
* Controls and monitors schedule changes and works closely with the team to ensure efficient and coordinated high quality patient care.
* Fielding phone calls emails, etc. from clinicians regarding their schedules.
* Daily collaboration with Clinical Team Managers, Home Care Utilization Navigator, paraprofessional department, and clinicians to promote high-quality patient-centered care.
* All other duties as assigned.
Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects VNA's commitment to CARES: compassion, accountability, respect, excellence and service.
* High school graduate or equivalent required.
* General knowledge of home care preferred.
* Some knowledge of insurance authorization/utilization process for home care preferred.
* Outstanding customer service and interpersonal skills.
* Must work well in a team setting which will promote the quality and efficiency of the team which positively impacts patient-care.
* Exceptional time management and organizational skills.
* Ability to perform detailed work independently without constant supervision in a fast paced environment.
* Must demonstrate efficient computer and technology skills.
