Evaluates patients referred to VNSNY Home Care program to determine appropriateness of admission. Promotes and fosters ongoing collaborative communication system with institutional personnel to establish coordinated home care. Manages and facilitates the safe and timely transfer of patients from a hospital or skilled nursing facility to the care of the Agency. Works under general supervision.
Responsibilities
Evaluates patients referred to VNSNY Home Care to determine appropriateness for admission and accepts or rejects patients based on Agency's admission criteria. Assesses and recommends accepted practice standards in accordance with established VNSNY policies and procedures.
Establishes and promotes ongoing collaborative communication system and works with institutional personnel (i.e., physicians, discharge planners, social workers, registered nurses, utilization review staff, dietitians, etc.) to establish a coordinated home care plan prior to patient's discharge.
Establishes a definitive home care plan in collaboration with the Coordinator of Care ("COC"), and makes clinical assessment of the appropriateness of the requested services, medical supplies and appliances, based on goals mutually acceptable to the patient and family, care provider, etc. for the optimal patient benefit. Ensures that appropriate supplies and/or medical equipment are readily available in patients' homes prior to discharge.
Collaborates with Operations management regarding various programs to ensure that the Agency is ready to meet patients' needs at the time of discharge. Participates in monthly team meetings in the region(s), as needed.
Explains the Agency's policies and services to patient and responsible family member(s) and advocates following home care assessment and referral. Supports and ensures adherence to the philosophy, mission and vision of the Agency through attitude and work ethics.
Determines coverage for requested home health services, confirms coverage availability with third party insurance, and informs patient or family member of source(s) and extent of coverage, and interprets reimbursement and coverage issues to hospital staff.
Compiles patient information from medical records and/or patients, submits requested information to Central or Regional Intake, and verifies eligibility, insurance information and the acceptance of cases. Provides patients and family members with written information on how to contact the Agency between time of hospital discharge and initial home visit.
Notifies VNSNY Home Care management of patients' acceptance for service and provides intake data, essential background information, care plan and signed medical orders. Develops, implements and evaluates systems to handle the management of referrals between the source of referral and VNSNY Home Care to promote continuity of care.
Provides educational and consultative resources to the institution concerning appropriate home care service and community resources. Interprets governmental regulations regarding home health care.
Provides statistical data of Home Care Consultant activities and referrals and submits them in a timely manner. Monitors/tracks referrals and assists Account Manager with any changes in referral patterns.
Establishes and promotes an ongoing collaborative relationship between the Agency and/or other facilities, direct care givers, physicians, nurses, discharge planners, case managers, social workers, etc. to ensure the coordination of appropriate referrals.
Transports and utilizes required medical reporting equipment using VNSNY designated/supplied carrying case weighing approximately 10lbs to and from hospital floors/care facilities.
Acts as an Agency representative at institutional and community programs and functions. Solicits business, provides information, as needed and market VNSNY programs/services through promotions, lectures, and health fairs.
Participates in the orientation of new Home Care Consultants and other Agency staff and acts a preceptor for new staff.
Assumes responsibility for professional growth to optimize clinical and managerial skill.
Participates in special projects and performs other duties, as required.
Qualifications
Licensure: License and current registration to practice as a Registered Professional Nurse, in New York State required.
Education: Diploma in Nursing from a state approved program - OR - Associate's Degree in Nursing from a state approved program with at least one year experience as a full-time staff nurse in a medical or surgical nursing area - OR - Bachelor's Degree in Nursing from a approved program accredited by the National League of Nursing - OR - Bachelor's Degree from a non-approved program supplemented by content which can be equated to the approved program required.
Experience: Minimum of one year of clinical nursing experience in a homecare, hospital or long term care facility OR successful completion of the VNSNY nine month associate HCC internship required. Experience in case management, administration or discharge planning experience in a hospital setting preferred.
