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Position Summary:
The Home Health Utilization Nurse is a member of the Primary Care Team and coordinates home health, quality improvement, and utilization review improvements for health center patients. The Nurse, as an integral part of the multidisciplinary care team, is responsible for conducting reviews in order to assess utilization, quality and tenure of services for identified home health patients.
Program Specific Essential Duties and Responsibilities:
·Works with provider’s/support staff to facilitate cost effective, quality care.
·Communicates determinations to providers and home care agencies in writing, adhering to Health Center, ACO and payer policies and guidelines.
·Review all home health agency communications and provide documentation as needed.
·Assist with DME requests
·Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine medical necessity, benefit eligibility, and network contract status.
·Refers all cases that do not meet medical necessity, benefit eligibility, and network contract status criteria for Provider review for consideration, ensuring the timely review of the referred case.
·Provides timely and frequent communications with the PCP and practice team to maximize the management of patient needs and related risk reduction.
·Acts as a liaison between assigned agencies, members/families, and the Health Center.
·Authorizes services, coordinates care, and ensures timeliness and coordination of health care services, in compliance with the health center, ACO and regulatory standards, seeking supplemental services when appropriate or when needed.
·Participate in monthly meetings with home health agencies and ACO
Program Specific Essential Duties and Responsibilities:
·Works with provider’s/support staff to facilitate cost effective, quality care.
·Communicates determinations to providers and home care agencies in writing, adhering to Health Center, ACO and payer policies and guidelines.
·Review all home health agency communications and provide documentation as needed.
·Assist with DME requests
·Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine medical necessity, benefit eligibility, and network contract status.
·Refers all cases that do not meet medical necessity, benefit eligibility, and network contract status criteria for Provider review for consideration, ensuring the timely review of the referred case.
·Provides timely and frequent communications with the PCP and practice team to maximize the management of patient needs and related risk reduction.
·Acts as a liaison between assigned agencies, members/families, and the Health Center.
·Authorizes services, coordinates care, and ensures timeliness and coordination of health care services, in compliance with the health center, ACO and regulatory standards, seeking supplemental services when appropriate or when needed.
·Participate in monthly meetings with home health agencies and ACO
·Refers high risk cases to the Care Management department, and/or other community services according to treatment protocol.
·Integrates quality improvement strategies to identify an opportunity to improve, test, and document an outcome of a care process to improve the quality of care. Includes safety and satisfaction as an outcome.
·Participates in QI initiatives that support Home Health Utilization. Assures that care is patient-centered and culturally sensitive
Supervisory Responsibility:
May be asked to provide guidance to LPNs, medical assistants or non-clinical Call Center staff by providing direction with protocols to facilitate patient care.
Qualifications and Education Requirements:
One of the following combinations of education and employment experience must be met in order to be considered for the position:
EducationAndExperience:
Bachelor’s degree in nursing required. Master’s degree in nursing or Public Health preferred.
Must be licensed as a RN by the Massachusetts State Board of Registration. BLS required.Home health experience and a clear understanding of the various home health line service lines available to patients is required. The ideal candidate would have home health discharge planning and utilization review experience (preferably with a health insurance company).
Full Time
Ancillary Healthcare
$85k-109k (estimate)
04/18/2024
07/20/2024
RHINELANDER, WI
50 - 100
2017
GREGORY R NYCZ
$5M - $10M
Ancillary Healthcare
The job skills required for Home Health Nurse include Home Care, Care Management, Initiative, etc. Having related job skills and expertise will give you an advantage when applying to be a Home Health Nurse. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Home Health Nurse. Select any job title you are interested in and start to search job requirements.
If you are interested in becoming a Home Health Nurse, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Home Health Nurse for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Home Health Nurse job description and responsibilities
Home Health Nurses provide a variety of tasks during patient visits depending on the specific plan of care and type of patient.
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After receiving their assignment, they drive to patients' home to perform the specified nursing care as ordered by the physician.
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Works with clinical healthcare professionals to coordinate home care.
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Home health nurses carry out the treatment prescribed by physicians or nurse practitioners.
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Home health care professionals keep a log for each visit and provide updates on the patient's condition to the doctor as needed.
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Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Home Health Nurse jobs
The educational requirements for a home health nurse are dependent on the following nursing certifications.
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Being compassionate and willing to work with families are also vital qualities of a home health nurse.
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To help others when they can't help themselves.
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Get Licensed as a Registered Nurse.
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Employers may prefer to hire nurses who have some previous nursing experience.
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Step 3: View the best colleges and universities for Home Health Nurse.