Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

• The Home Health Access Nurse Coordinator (HHANC) is a RN who practices as a full partner within the continuum of care and consistently demonstrates clinical expert patient intake and care coordination. The HHANC triages complex referrals with providers and key stakeholders to assure a safe transition to home. The HHANC promotes the Central Intake Department as the hub for transitioning patients to post-acute care at home.
• The HHANC possesses knowledge, skills, and attitudes that promote thorough and efficient processing of referrals from inpatient and ambulatory care settings including internal and external partners. The HHANC develops and maintains collegial partnerships that engenders trust and confidence with referral sources
• The HHANC acts as a gatekeeper by tracking referral volume during peak and low volume times. The INC communicates workflow issues and works to assure adequate resources are available to meet the department demands.
• The HHANC coordinates and independently ensures safe transitions in patient care through expert knowledge of post-acute care. The HHANC works with the HCHS Scheduling Department to ensure the patient is seen in a timely manner by the correct agency(s).
• The HHANC works closely with the inter-professional teams to facilitate coordination of home care, home infusion, hospice and palliative care while providing clinical leadership and guidance to the Central Intake non-clinical staff by serving as a preceptor and charge nurse.
• The HHANC complies with regulatory standards for all licensing and accrediting bodies.
• The Central Intake Department services all agencies under Home Care and Hospice Services which includes Penn Care at Home, Penn Home Infusion Therapy, Caring Way, and Wissahickon Hospice.

Responsibilities:

• Continuous Quality Improvement: The nurse utilizes data to identify potential and actual problems and opportunities to complete referrals in a safe, timely, efficient, effective, and equitable.
• Provides quality review for high risk/complex referrals
• Integrates compliance tasks into the referral process including completion of appropriate OASIS and obtaining Face to Face information
• Strives to achieve excellence of service
• Communication:
• Develops specialty service line knowledge in home health, palliative care, hospice care, infusion, treatments, labs and care settings
• Communicates effectively with referral sources, team members, leadership, schedulers
• Possesses knowledge of policies to ensure safe transition from hospital or facility to home
• Maintains confidentiality in accordance with HIPAA
• Accesses information to stay current on changes and trends in the home health and hospice industry as it pertains to referral and intake processes
• Leadership: The nurse effectively collaborates and applies innovative, systems thinking to engage in systematic, evidence based problem solving and decision making to promote effective changes within a complex care delivery system supporting the vision of HCHS and Penn Medicine
• Supports department staff to assure excellent customer service through role-modeling, feedback, and mentorship
• Person and Family Centered Care:
• Effectively uses all resources to achieve positive outcomes and high satisfaction for patients
• Professionalism: The nurse demonstrates a commitment to the nursing profession through lifelong learning, adherence to ANA’s Code of Ethics for Nurses, participation in a professional organization and advancing community outreach.
• Partners with referral sources to establish trust and exquisite communication
• Safety: The nurse minimizes risk of harm to patients, families, providers and self through system effectiveness and individual performance
• Identifies high-risk and complex patients/therapies/medications and coordinates same day services with clinical team partners
• Assures timely start of care in collaboration with the Scheduling Department
• Teamwork: The nurse effectively engages in the process of cooperation, coordination, and collaboration in an effort to provide for safe, quality outcomes for patients within inter and intra-professional teams, including virtual teams.
• Exhibits strong customer service and relationship building skills with internal and external referral sources
• Effectively tracks and communicates regarding readmitted patients to ensure a safe discharge
• Works closely with discharge planning group to determine needs for home care and makes recommendations
• Provide hospital personnel most directly involved with patient’s care thorough communication regarding the home care plan
• Treats people respectfully
• Technology/Informatics: The nurse utilizes appropriate information and technology to communicate, manage knowledge, mitigate error, and support decision making across the continuum.
• Obtains all clinical information relevant to the referral including diagnosis, agency, referral source, following provider, treatments and medications
• Develops extensive working knowledge of EMR-Penn Chart, multiple secondary platforms

Credentials:

• RN or RN-NJ (Required)
• Case Management RN

Education or Equivalent Experience:

• Bachelor of Science (Required)
• Nursing 5 years Current acute care (med/surg/ICU) nursing experience; Leadership: formal or informal (charge RN, committee chair) preferred Home care and hospice experience preferred

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.