PURPOSE: The purpose of this position is to assist the carrier in coordination of worker’s compensation patients home care needs once home health care is established until the case is closed by the carrier and/or discharged by the physician.
•Responsible for the completion on any portion of referral intake process that the Intake Coordinator was unable to complete, if any
•Facilitate flow of evaluation(s), orders, and progress notes from provider(s) to Nurse Case Manager or adjuster per OCCM nursing department protocol
•Review MD orders, initial assessments/evaluations and progress notes on patient, and communicate with provider and carrier per OCCM Nursing department procedure to provide updates and ensure progress of patient
•Locate provider(s) or contact established provider(s) to arrange additional service for current patient
•Communicate with Nurse Case Manager/adjuster and/or provider to ensure appropriate physician orders are obtained and followed
•Contact Nurse Case Manager or Adjuster to obtain authorization for additional or continued service(s)
•Create purchase order(s) per OCCM Nursing department procedure to authorize additional or continuation of service(s) to provider
•Utilize appropriate tracking tools, i.e. authorization logs, Outlook Calendar or Task function, to ensure follow-up on critical timelines as outlined in OCCM Nursing department procedures for obtaining evaluations/notes, tracking authorizations, and contacting carriers
•Coordinate quality assurance issues or concerns involving patient care, retrieval of evaluations and/or notes, and authorization of services closely with assigned Quality Assurance nurse
•Maintain thorough, up-to-date documentation on each patient in patient database
•Close file per OCCM nursing department procedure once Nurse Case Manager or adjuster cease authorization or physician discharges from home care
•Rotation for Nursing Department on-call schedule per OCCM Nursing Department procedure
•Intake referrals for home care, supplies or additional services offered by OCCM, data entry referral into patient database, and follow-through on intake process per MSC nursing department procedure
•Notify appropriate OCCM department(s) of referrals requiring their expertise
•Assist in training new associates as requested by Nursing Department Training Leader
KNOWLEDGE, SKILLS, and ABILITIES and OTHER CHARACTERISTICS:
•RN, LPN, or MA with a minimum of 2 years experience in acute setting, home care, or front and back medical office
•Knowledge of Microsoft Word, Excel, and Outlook
•Ability to learn the company’s patient database and adapt to any system changes
•Ability to communicate and express ideas; both written and verbal
•Ability to organize work flow in a dynamic, fast-paced work environment
•Ability to maintain a courteous and professional demeanor in all customer interactions
•Ability to follow instructions and meet strict deadlines
•Ability to work in a team environment
•Ability to read and interpret MD orders and all discipline notes
•Ability to adhere to company policy and procedures, HIPAA and state legislation regarding workers’ compensation and home health care
•The Associate communicates effectively, both verbally and in writing, with individuals inside and outside the Company.
•The Associate works effectively and relates well with others.
•The Associate exhibits a professional manner in dealing with others and works to maintain constructive working relationships.
•Self-motivated; career-oriented; organized; able to handle stressful situations and take constructive criticism; and not afraid to learn or take on new responsibilities.
One Call Care Management - 9 months ago
No one looks forward to managing a Workers' Compensation claim. It can be a complex, time-consuming and costly experience. You need a...