Clinical Care Coordinator RN - Continuing Care

Job Summary

Evaluates referral sent into Central intake via fax folder or online for completeness and appropriateness of Home health from information provided or needed. Serves as a liaison between the agency and the referral source ( hospitals, clinics and the medical community) to ensure the continuity of care of patients, education of the community and the medical professional regarding home care services.

Essential Functions

• Works closely with hospitals, clinics, health care facilities, MD practices and agency clinical and administrative personnel to ensure referrals for patient care needs are sent to Home Health agency as seamless, efficient, effective, appropriate and complete information as possible at the time of the referral. Requesting additional information as needed.
• Interacts daily with referral sources, medical professionals , Account executives and the home health agencies to achieve continuity of care, coordination of medical care needs of patients by determining all ordered disciplines, equipment and care needs are addressed as recognized on referral info and sent to appropriate agencies or outside agencies as deemed necessary.
• Evaluates the appropriateness of the patient's admission to home care from referral information and provides education of Home health requirements to referral sources as needed.
• Receives referrals and orders from physicians, hospitals and other agencies and acts as a resource for clinical team members.
• Establishes lines of communication among appropriate agency personnel and personnel of area health facilities to assure a flow of information and provide a continuum of care.
• Maintains referral list and follows up as needed until patient is sent to be data entered or determined not appropriate for Home health.
• Responsible for quality assurance on patients in workflow in order for workflow to get to branch for scheduling of patient.

Physical Requirements

Works in a fast paced environment with time deadlines. Ability to communicate verbally and in writing. Requires long periods of sitting, manual dexterity and use of computer terminals. Requires adequate vision to read and interpret instructions. Must be able to respond quickly to changes in assignments. Must be able to lift and support the weight of 35 pounds in handling patients, medical equipment, and supplies Each employee has the responsibility to work in a safe manner. Physical abilities testing required. Additional department specific physical requirements may be identified for unique responsibilities within the department by the nurse leader.

Education, Experience and Certifications

Graduate of an accredited school of nursing. BSN preferred. Current RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside or; if declaring a National License Compact (NLC) state as your primary state of residency, meet the licensure requirements in your home state; or for Non-National License Compact states, current RN license or temporary license as a Registered Nurse Petitioner required in the state where the RN works. Minimum of two (2) years nursing experience. Prefer one year in home health, managed care or discharge planning. Current Driver’s License. Additional education, training, certifications, or experience may be required within the department by the nurse leader.