UR Medicine Home Care
Provides advocacy, management, and coordination of health and wellness services and care for assigned members. Promotes the goals of maximum independence and prevention of hospitalizations, and instructs on safety, disease processes, evidence-based health strategies, and quality of life interventions. Educates members and caregivers in covered services and benefits, and assists in the access to medical, psycho-social, and environmental resources, provisions, and services.
Interfaces with members, caregivers, internal and external Interdisciplinary Team members, referral sources, and vendors.
- Works autonomously to provide Care Management/Coaching, health and wellness education, and coordination of healthcare services to an assigned caseload of members.
- Develops comprehensive Plan of Care (POC), and conducts ongoing assessment to ensure appropriateness of care and services, as well as cost-effective utilization. Evaluates members’ response to POC and progress towards goals, and makes modifications as necessary.
- Conducts phone, and/or in-home/facility assessment visits in order to update the POC, according to workflows, DOH regulations, and agency policy and procedures.
- Conducts as needed assessments when required, and makes appropriate referrals to ensure prevention of hospitalization, and that all clinical needs are met in a timely manner. Makes referrals to appropriate health and community resources as needed; providing relevant information, and assisting members with accessing. Refers skilled services, including nursing, therapies, and social work as needed to meet the safety, medical, and psycho-social needs of the members.
- Communicates with members and their caregivers, Health Care providers, Interdisciplinary Team members, and associated vendors to ensure continuity of care.
- Processes service authorization requests according to workflows and within expected time frames. Approves/denies requests according to, and within the framework of covered benefits and services.
- Makes notification to member/caregiver of outcome of approval/denial and provides rationale in writing and via phone.
- Creates authorization requests for vendors to accompany approvals, and ensures accuracy of authorizations created. Ensures authorizations are sent to vendor in a timely manner to prevent a lapse in member services. Orders supplies, equipment, and other covered items for members according to workflows and expected time frames, ensuring no lapse in receipt occurs.
- Documents all communications, requests, and changes in condition along with associated interventions in appropriate data base.
- Receives and coordinates notification of all emergent/urgent visits, acute hospital and/or SNF admissions and discharges. Follows members through any hospitalizations/admissions, and coordinates necessary discharge follow up to ensure continuum of care.
- Educates members/caregivers on services and benefits.
- Researches, updates, and maintains integrity and confidentiality of member charts.
- Participates in Quality Assurance and improvement activities.
- Participates in case conferences and service authorization/utilization conferences with Manager.
- Other duties as assigned.
- NY State Licensed Registered Nurse.
- One to three years nursing experience as Care Manager/Care Coordinator/Case Manager in Managed Care environment and/or Community Health preferred.
- Working knowledge of Community Health/Home Care and Medicare/Medicaid regulations preferred.
- Prior experience in an interdisciplinary service delivery environment.
- Strong assessment and comprehensive care planning/managing/coordinating skills.
- Ability to work independently.
- Strong organizational, interpersonal, and communication skills.
- Strong problem solving and crisis intervention skills.
- Ability to demonstrate strong computer knowledge/skills.
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