Major Responsibilities:

Practices and creates an environment that supports and sustains effective communication with internal and external customers. Develops and sustains relationships that enhance effective coordination of care and increases referral base. Provides support in the delivery of quality clinical care 1)Responds courteously and positively to client requests and concerns and assures appropriate resolution. 2)Performs other duties as necessary, i.e., on call rotation. 3)Serves as first line of phone call for patients and primary care physicians office. Provides disease management education for high risk patients. 4)Provides basic case management to review symptom control wtih the patient, prescription refills, scheduling/retrieving results on diagnostics, labs, consultant visits and procedures. 5)Inerfaces communication between APN and RN and other service providers. This includes case management, home health, hospice, primary care physician, physician specialists and hospital staff. 6)Documents coordination in both provider EMR and agency EMR when necessary. 7)Participates in daily care coordination call for Physicians at Home as indicated 8)Participates in weekly IDT for Palliative Care as indicated 9)Functions as a clinical support for the practice. Attentive and responsive to the needs and concern of patients, staff and providers. Works closely to resolve issues with involved parties. Completion of referral process for appropriate Advocate departments. 7)Assists patients in obtaining additional services ordered by provider after a visit 6)Accurately follows up on any services ordered including medical tests or services. Communicates any delays in obtaining test or result with provider and RN. Communicates test results with provider following appropriate policy and procedure for the site. 1)Completion of referral process for appropriate Advocate departments. 2)Contacts appropriate staff to schedule the first visit. 3)Ensures data entry into the system is complete for the referral, insurance requirements, and medical necessity support through researching medical history 4)Contacts APN or RN upon referral and collects necessary clinical data. 5)Schedules initial and subsequent appointments for APN, RN and social worker visits as needed. Responsibile for the screening of referrals to ensure all new patients meet agency admission criteria and comply with state and federal regulations and support the growth key result area. 6)Explores reimbursement in conjunction with Insurance Verification specialist / Patient Account Specialist. 7)Verifies patient lives in geographical coverage area and that patient and physician have agreed to services. Ensures demographic information for patient is correct 3)Identifies risk management situations and reports to supervisor immediately 1)Processes referrals for all programs for Physicians at Home and Palliative Care. Determines whether appropriateness of Physicians at Home and Palliative care based on established guidelines of Advocate at Home and Post Acute Network in conjunction with Insurance Verification Specialist and Patient Account Specialists 4)Interprets company services, admission criteria and medical policies to referral sources and individuals seeking information. 2)Responds to all inquiry calls regarding Physicians at Home and Palliative care 5)Maintains a knowledge of Medicare, Medicaid, HMO procedures and Managed Care guidelines. 8)Assists with maintaining accurate patient census for all PAN programs

ONGOING:

Contributes "best thinking" to the organization, share experiences, education and insight with peers associates and home care leadership. Question/Challange the status quo and suggest better ways of doing things

Licensure:

Nurse, Licensed Practical (LPN)

Education/Experience Required:

LPN with 3-4 yrs. experience; 1-2 yrs. in hospice, home care, physicians office or palliative care.

Knowledge, Skills & Abilities Required:

• Very good communication skills. Knowledge of Medicare rules and regulations.
• Customer Service skills
• Working knowledge of managed care environment

Current LPN License Valid Drivers License Physical Requirements and Working Conditions:

• On call rotation for after hours referral phone calls.
• Ability to work in a fast paced environment with established time constraints
• Ability to cooperate and work with others
• Ability to make sound and timely decisions Must be able to travel to various PAN offices for meetings or to offer care coordination support.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.