CT Candidates need to be able to work in the City or State specified – Telecommute
Lead Nurse Coach – (Remote – Connecticut )
Job Locations: Remote
Job ID: 2019-7200
Category: Clinical / Post Acute Care
The HomeSTAR Care Transitions Program assists in reducing hospital readmissions of clinically complex patients. The program couples patient education/coaching with home health interventions to assist a patient’s transition home after a hospital stay.
The Lead Nurse Coach utilizes clinical expertise, receives/responds to incoming calls from external sources, assists the Supervisor and Manager with coaching, training, call monitoring, reports and mentoring of new associates. Acts as a clinical resource to department nurses and care coordinators with day to day activities, providing job-related expertise and clinical knowledge. Acts as a subject matter expert for the HomeSTAR internal team.
Using clinical expertise, reviews utilization information concerning patient care and matches those needs to available care options, within the HomeSTAR Program and specific plan payer criteria.
Assists Supervisor/Manager with coaching, training, call monitoring, reports and mentoring of new associates.
Manages the transition of assigned HomeSTAR patients from acute care setting to the home setting utilizing telephonic outreach and teaching methods combined with facilitating in home health care services to accomplish the goals of the HomeSTAR Program. case management combined with facilitating home health nursing services.
Initiates outbound calls to HomeSTAR patients, hospitals, discharge planners, physicians, and home health agency nurses providing education regarding the benefits of HomeSTAR.
Engages HomeSTAR patient in the program and administers initial assessments, progress surveys and discharges surveys utilizing clinical expertise and judgment.
Obtains and reviews home health agency program documentation, medication reconciliations and surveys.
Manages comprehensive home health needs of the patient while participating in HomeSTAR.
Makes on-going reauthorization decisions for health plans. Issues service reauthorizations for the home care provider based on medical necessity and payer benefit guidelines.
Documents all interactions, guidance and interventions in CareCentrix applications ensuring documentation guidelines are maintained.
Facilitates obtaining appropriate home health physician orders for home care services.
Acts as a clinical resource for unlicensed HomeSTAR Care Coordinators, providing clinical expertise and helping to clarify referral source directives. Receives/responds to requests from unlicensed staff regarding scripted clinical questions and issues.
Makes on-going reauthorization decisions for HomeSTAR patients and issues service reauthorizations for the home care provider based on medical necessity and payer benefit guidelines.
Contacts referral sources to advise them of referral status. Relays referral status and updates to the assigned health plan case managers.
Communicates customer service/provider issues to supervisor for logging and resolution.
Participates in and contributes to ongoing quality assessment/improvement activities, ensures the collection of data for improvement analysis and prepares reports as requested.
Assists team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
Participates in implementing / maintaining operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
Registered Nurse with licensure in the state(s) of practice required.
Expertise in Telephonic Case Management and knowledge of URAC standards
Broad knowledge of health care delivery/managed care regulations, contract terms/stipulations, prior Case Management/review experience, and governmental home health agency regulations required….
Case Management , Nursing