Home Health Care Coordinator

Company

Since 2012, this client has been a trusted partner for the nation’s top health plans, health systems, post-acute care providers, and at-risk physician groups navigating the shift from volume to value. Their high-touch, proven care model fully supports patients from pre-acute through to the home. This client's patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions.

Overview

Required skills & experience: • Bachelor’s degree required • Active, unrestricted registered clinical license required – Registered Nurse, Physical Therapist, Occupational Therapist, or Speech Therapist • For registered nurses, an active nursing license in the state in which performing services is required • 3 - 5 years of experience in geriatric care management in a home health setting required • At least 2 years of experience in an acute care setting preferred • At least 2 years of recent experience in case management or utilization management role • Excellent written skills and oral communication skills to complete the role telephonically • Case management experience preferred • Knowledgeable with NCQA and URAC standards a plus What you need to know: • The Home Health Care Coordinator (HHCC) is responsible for the management of authorization requests for home health services in accordance with CMS and nationally recognized standards. • As a member of the Home Health management team, the HHCC reviews clinical documentation from home health providers and evaluates the medical necessity of requests for services by utilizing InterQual or internally developed clinical criteria. As necessary, the HHCC collaborates with our Medical Directors and/or health plan care management staff to determine the most appropriate course of action for a member based on clinical factors. • Document requests for authorization for home health into naviHealth’s clinical documentation system. Review OASIS documentation from providers and utilize InterQual criteria to determine medical necessity and appropriate authorization for home health services. • Understand and apply CMS Chapter 7 guidelines for home health. • Follow up with providers as necessary for clarification of clinical documentation of patients’ status. • Facilitate referrals to appropriate care management services as indicated based on patients’ needs. • Identify and coordinate any post-discharge needs for patients. • Collaborate with intake team, home health team, appeals/denials teams, and Medical Directors to ensure efficient processing of home health authorization requests in accordance with mandated turnaround times and quality metrics. • Notify the health care provider of denials reviewed by the Medical Director. • Participate in the regular review of departmental reports on key quality metrics and identify opportunities for systemic improvement. • Maintain active clinical licensure and knowledge of nationally recognized utilization management, CMS home health regulations, NCQA and URAC standards of practice. • Attend team meetings as requested.

Benefits