LPN - Authorization Coordinator - Home Health Job

Full Job Title: LPN - Authorization Coordinator - Home Health

Job Number: 17008139

Facility: SSM Health System Office

Location: St. Louis, MO

Schedule: Occasional/Subs

Hours: 8am-5pm

Description

Role Purpose:
Delivers excellence in customer service to exceed customer expectations. Reviews and analyzes patient referrals to determine appropriateness of Home Health, Hospice and Infusion services, ensures compliance with payer regulations as applicable, and identifies most the most appropriate level of service. Coordinates and expedites all aspects of service to optimize patient's smooth transition from Hospital to home care. Is a patient advocate and liaison between Hospital Case Management, Physicians, patients and SSM Health at Home clinical staff. Communicates key components of patient's needs and physicians orders to HC Clinician's to help establish patient's plan of care. Coordinates the delivery of equipment and/or supplies based on patient and families need. Collaborates with Clinical Sales Liaisons to provide educational information to Case Managers, Physicians, key hospital staff, and nursing home staff regarding qualifying criteria, access to services, etc.
Responsibilities:
    • Coordinates identification of Home Health and Hospice patients in conjunction with Hospital Case Management. Conducts in person meeting with patients/family to discuss needs and services and verify patient information, and identifies the clinical needs and screening to ensure criteria for admission is met. Ensures medical necessity by verifying procedure/diagnosis compliance, ensuring proper screening, communicating general instructions to customer. Adheres to all regulatory compliance per department policies, as evidenced by quality audits and reviews. Identifies which service line/program is most appropriate for patient, based on his/her needs, and explains services to patient/family.
    • Verifies Attending Physician for patient and ensures compliant F2F and final orders are obtained prior to Start of Care as appropriate. Ensures ongoing follow-up with referral source, until patient is discharged, to evaluate patient needs, including but not limited to disciplines, equipment, wound care, infusion, etc. Identifies and/or triages proposed SOC/ROC date in conjunction with Clinical/Scheduling Supervisor. Communicates/notifies Scheduling/others of referral SOC/ROC. Initiates/Generates SOC orders and collaborates notification of patient to Health at Home Care Team (including Associates, Clinicians, Supervisors and Managers) through verbal, written and/or huddles.
    • Reviews all components of EPIC record and/or Medical information received via fax/scan. Ensures all appropriate pertinent clinical information and pertinent communication needed to convey to Clinical Staff is documented into the Horizon EHR through referral information notes and orders. Reviews documentation entered into system to ensure quality clinical and accurate data. Verifies patient, related party, demographic information and obtains insurance information; in conjunction with Associate. Hands off to Associate for Data Entry and Verification of Insurance.
    • Demonstrates streamlined processes to maintain safety and quality through accurate patient identification, protects personal health information, and proactively obtains and interprets physician orders, as evidenced by quality audits and reviews.
    • Provides exceptional customer service and notifies Marketer/Manager of any physician or referral source complaint/concerns. Serves as a resource/Advocate to hospital staff, patients, families, extended care facility staff and physicians regarding all Home Services provided. Collaborates with Clinical Sales Liaison to develop relationships with case managers, Hospital Case Managers and physicians through positive and professional communication.
    • Enhances effective operations of the department through participation in department meetings, reads and initials minutes for meetings not attended, participation in process improvement activities to achieve goals, as evidenced by attendance record and completed process improvement action items. Assists in the development of Orientation Manual, Checklists and Guidelines. Assists in the training and development of Associates and Admissions Liaisons.
    • Rotates weekend coverage, Holiday coverage and on call coverage, as assigned.
    • Serves as liaison between SSM hospitals, SSM Health at Home and internal/external customers to promote collaboration and partnership to achieve excellence in post-acute community care.
    • Coordinates all levels of care including Infusion, Home Health and Hospice demonstrating high level clinical knowledge and skills.
    • Performs other duties as assigned, such as special assignments.
    Qualifications
    Minimum Requirements:
    • Graduate of accredited school of nursing: Licensed Practical Nurse.
    • Current Missouri LPN license
    • Valid driver's license required
    • 1 years as an LPN in a clinical health care environment experience required; Home Health, Hospice, Physician Office or Med/Surg experience highly recommended
    • Typing/keyboarding, Microsoft Office
    • Requires effective oral and written communication skills to communicate with customers.
    • Requires effective decision making, critical thinking, clinical assessment and problem solving skills.
    • Effective interpersonal communication skills are required to communicate in a positive manner to internal and external customers.
    • Understands and incorporates team concept in daily activities.
    • Assists team to achieve goals by being helpful, dependable and flexible.

SSM Health at Home –

SSM Health at Home offers highly skilled and experienced caregivers to help patients through difficult times. Services include extended at-home care, help managing pain or special support during terminal illnesses. SSM Health at Home is located in Illinois, Missouri and Oklahoma.

SSM Health is an Equal Opportunity and Affirmative Action Employer. Qualified applicants are considered for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected by law. Learn More »


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