Healthcare Coordinator

Job Summary:

The Intake Coordinator is a vital role within our organization, responsible for coordinating new referrals and ensuring that all new patients meet our agency's policies and procedures, as well as federal and state regulations and guidelines.

• Patient Care:
  • Maintain a working knowledge of current home health coverage guidelines, admission criteria, documentation requirements, coding guidelines, and care planning with case conference.
  • Effectively manage initial home visits, introducing services, admission criteria, process for determining patient eligibility, and obtaining required consents when eligibility is confirmed.
  • Assess patient/caregiver willingness, ability, and barriers to learn patient care techniques and for achieving independence in care; document patient and family response to teaching.
  • Outline aide care plan; perform ongoing home health aide oversight, revise aide care plan based on patient progress; evaluate home health aide care every 14 days or per state payer requirement and state regulations.
  • Supervise CAN participation in patient's plan of care and performance of skilled interventions at intervals defined by state regulations.
  • Initiate the plan of care and related nursing interventions; conduct goal-oriented visits; ensure other nursing team members have information needed for continuity of care and continued progress.
  • Provide patient/family teaching per POC; assess and document response to teaching.
  • Advocate for the patient as required.
  • Complete an accurate, initial comprehensive head-to-toe assessment. Complete for home health patients, an OASIS, and other assessments of patient and family to determine home care needs; obtain a history of current and previous illness(es).
  • Use health assessment data, input from agency team members, the physician, patient, and family to determine patient needs.
  • Effectively manage patient and family expectations regarding agency services, outcomes/discharge goals, and ability to achieve independence in care.
  • Establish appropriate primary and secondary diagnosis based on patient assessment and focus of home health care.
  • Develop a care plan, incorporating appropriate skilled interventions, and necessary medical supplies/equipment and ancillary/specialty services, to achieve outcome/discharge goals.
  • Protect realistic home health visits by discipline and medical supplies required per planned interventions and discharge goals. Write POC orders accordingly.
  • Regularly evaluate home health patient's progress, in collaboration with team members; revise patient POC accordingly.
  • Perform ongoing appropriate OASIS assessments and revise POC accordingly.
  • Identify home health patient's discharge planning needs when developing the plan of care; identify and implement community referrals prior to patient discharge; determine patient readiness for discharge based on expected outcomes, goals, and coverage guidelines.
• Coordination:
  • Prepare clinical notes and other required documentation within the required timeframes.
  • Obtain/receive physician orders as required for treatment changes; communicate new/changes orders to appropriate team members.
  • Track all assigned cases, organize schedule to ensure all patients' needs are met per their individual POC.
  • Meet agency productivity requirements.
  • Request PTO in advance per agency protocol.
  • Communicate with the Clinical Supervisor regarding the coordination of the plan of care, need for overflow, weekend, and after-hours nurse assignment.
  • Ensure the availability of equipment/supplies and other necessary items to support care plans; use equipment/supplies per plan of care and document per agency policy.
  • Provide instruction for other team members.
  • Provide updates for the primary physician when necessary and at least every sixty days.
  • Facilitate ongoing care discussions and team case conference discussion of the patient goals, progression, needs for ongoing care, and revise goals and/or interventions to enhance patient progress toward discharge.
  • Plan and coordinate assignment of clinical staff to clients with input from the Home Health Director, Administration, and Physician as needed.
  • Work cooperatively with other staff members in coordination of patient care services and disciplines.
  • Act as liaison between clinical staff and community health care providers by communicating changes in patient status and care as appropriate.
  • Evaluate potential referrals, including review of facility documentation.
  • Become aware of Level of Care issues related to home care, and familiar with insurance reimbursements.
  • Participate and assist in case conferences, in-services, and meetings as needed.
  • Work with personnel or other community agencies involved in the client's care as directed by the Home Health Services Director and Administrator.
  • Coordinate with agency Team Coordinator/Staffing Specialists insuring appropriate staffing coverage for new referrals.
  • Coordinate with agency RN Case Managers and clinical staff to assure efficient admission of new referrals.
  • Ensure effective and timely coordination of client home care services through the timely completion of required documentation and computer data entry for new intakes, as well as timely transfer of pertinent medical data to client's physician, therapists, and agency staff members.
  • Maintain accurate and comprehensive client medical data throughout the intake process.
  • Notify Branch Manager regarding proposed changes that may affect the intake process.
  • Investigate and take appropriate actions on client/consumer complaints.
  • Attend weekly Team Coordinator/Staffing Specialist meetings to insure consistent lines of communication regarding new intakes and existing cases needing staffing coverage.
  • Supervise Team Coordinators to ensure effective handling of clients' schedules.
  • New referral coordination assures agency intake processes meet applicable local, state, and federal licensing/regulatory requirements in addition to agency policies and procedures.
  • Direct the recertification process every sixty days by obtaining a roster of all patients with plan of treatments that are to be recertified and establishing completion of this process timely.
  • Review medical records and update treatment plan forms.
  • Audit medical records on each patient at the time of recertification, complete appropriate audits, and forward to Director of Patient Care Services.
  • Review recertification treatment plan summaries for transcribing or typing errors prior to Registered Nurse review and submission for physician's signature.
  • Correlate recertification audits with OASIS audits, quarterly chart audits, and adverse event audits.
  • Assist Billing Coordinator with billing audits as necessary.
  • Communicate effectively to obtain patient information for ordered services.
  • Develop working relationship with hospital and insurance case managers to provide quality, compliant care.
  • Ensure all needed clinical information is provided to insurance companies to obtain authorization of services.
  • Maintain client dashboard for pending referrals requiring authorization.
  • Upload authorizations into patient's electronic chart.
  • Enter authorization information for patients into electronic system.
  • Participate in team conferences to discuss patient's needing authorization.
  • Maintain confidentiality of company and patient information.
  • Provide proper notification and/or advance notice of absence or tardiness without abuse.

• Participate in personal, professional growth and development, maintain current licensure. Independently seek learning opportunities.
• Participate and contribute to QAPI program.
• Attend all in-services training sessions and programs required by agency.