Job Category: Nursing - Registered Nurse Work Shift/Schedule: 8 Hr Morning - Afternoon Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
Job Summary Responsible for coordinating the Access Center of the hospice program including the Intake and Admission Nurses. Responsible for coordinating the different hospice levels of care to appropriate patients. Responsible for day to day management of patient care admission activities and supervision of clinical personnel to ensure excellent patient care outcomes and in compliance with state and federal regulations, organizational policies and accreditation standards.
Responsible for the hiring, training, development, competence, and retention of intake and admission staff. Monitors and assures the proper utilization of resources striving to improve financial targets. Provides admission training to clinical staff and assists with admission visits as needed.
Minimum Job Qualifications Licensure or other
Registered Nurse from a state approved University or school of nursing. Current professional licensure. Maintains BLS certification.
Educational
Associates Degree. Minimum
Four (4) years of clinical experience, preferably in hospice or home health with Bachelor's degree; Associate's degree and 6-7 years equivalent experience considered. Proven ability to work within an interdisciplinary setting. Other: Preferred Job Qualifications Preferred Licensure or other
CHPN. Preferred Educational
Bachelors Degree in Nursing. Preferred
Management experience. Other: Job Specific and Unique Knowledge, Skills and Abilities Strong interpersonal and communication skills. Sense of humor and empathy with ability to mentor, lead and develop staff.
Clinical skills, organization, and management skills. Proficient with computers and software applications. Organized with an ability to set priorities and use time effectively.
Excellent critical thinking and decision making skills. Ability to handle a workload that fluctuates greatly based on rapidly changing situations. Ability to understand complex Medicare/Medicaid regulatory and accreditation requirements and standards, policies and procedures.
Excellent skills in organization and attention to detail. Action and goal oriented. Self-directed.
Ability to analyze and correlate clinical care with financial and regulatory requirements and accreditation standards and to propose and implement processes to ensure compliance with same. Essential Tasks and Responsibilities Responsible for Human Resource management of all direct report staff. Responsible for recruitment, hiring, development, supervision, and retention of all direct report staff positions.
Ensures effective communication with staff via meetings and other formats. Ensures competence and quality of care delivering a high standard of care delivery. Conducts quality monitoring, documentation audits, performance evaluations and counseling to direct staff to ensure compliance with policies and procedures, state and federal regulations and accrediting bodies.
Responsible for intake and admission staff productivity and efficient resource utilization. Ensures work schedules and assignments of staff to ensure adequate coverage to meet patient/family and of the organization needs of the organization. Collaborates with the Hospice Leadership Team to ensure optimal functioning of intake/admission department.
Directs the implementation of improved work methods and procedures to ensure nursing services are delivered in accordance with regulations and policy. Participates in the development and implementation of annual Performance Improvement Plan. Serves as a member of the Survey Readiness Team.
Reviews all standards annually and participates in action plans as indicated. Oversees and coordinates as needed all admission training of clinical and other IDT staff. Assists the Hospice Executive Director in preparation of an annual budget for the intake and admissions department and monitors and controls allocation of resources according to budgetary limitations.
Identifies opportunities for additional or improved services to address unmet customer needs. Participates in development and revision of policies and procedures as appropriate. Supervises the planning and delivery of patient/family care and provides guidance in communication, coordination and effective operation relating to patient care, utilizing clinical knowledge and knowledge of current regulatory and reimbursement changes.
Maintains a monthly schedule to ensure appropriate level and skill mix of staff to meet patient/family needs. Follows productivity standards for staff and controls case pay usage. Schedules staff fairly.
Oversees the Intake and Admission department staff. Works with staff to develop processes and staffing to provide rapid response to all referral source requests, encouraging open access approach to all appropriate referrals. Develops and maintains the database to ensure that accurate and adequate data is recorded and maintained.
As needed, conducts consults and admissions with patients/families. Fosters a positive and creative approach to challenging referrals and patient/family situations. Approaches all identified concerns with strong service recovery approach.
Ensures facilitation of the referral and admission process of hospice services for efficient and effective continuity of care. Processes referrals to assure efficient pre-qualifying of patients. Demonstrates knowledge regarding the scope of services and of all policies and procedures of the organization.
Communicates effectively with referral sources and team members to support the business partnerships being developed by the organization. Provides excellent customer service, speaking clearly and communicating information in a manner appropriate to the caller/audience. Obtains thorough medical, demographic, and financial information on all referrals and ensures optimal communication with patient care managers and/or admitting clinician for smooth transition to services.
Ensures patients are called to notify and verify information/obtains directions to patient home. Identifies the need for an interpreter as appropriate. Demonstrates a clear understanding of advanced treatments hospice can provide and coordinate the delivery of these services as needed.
Consults with attending Physician and/or Hospice Medical Director to determine appropriateness of referral for admission to the hospice program based upon Medicare/Medicaid/intermediary requirements and admission criteria. Ensures that all possible options are exhausted to assist the referral sources to meet the needs of the patient, even when services are not ordered or the patient is not eligible for services. Ensures accurate and timely processing of all hospice referrals and associated orders and certifications.
Ensures that all possible options are exhausted to assist the referral sources to meet the needs of the patient, even when services are not ordered or the patient is not eligible for services. Assists with referral to other community resources when a referral does not meet criteria for hospice admission. Provides education and updates staff on changes in medical and financial requirements regarding hospice admission and coverage.
Supports the achievement of admission goals by conducting conversion follow up calls on referrals not admitted. Coordinates as needed with leadership staff on process for follow-up calls. Coordinates care to ensure that new admissions have appropriate medical equipment, supplies and medications arranged for safe, efficient and excellent care for the patient and family/caregivers.
Communicates effectively with vendors. Develops processes and systems to ensure accuracy of medical equipment, medication and treatment orders. Obtains certification of terminal illness for all planned admissions.
Ensures that all Intake information is verified and entered into the clinical information system. Demonstrates knowledge of and ability to operate current software programs, clinical and office. Ensures entry of all referrals into the information system and assigns appropriate number.
Keeps accurate records concerning referrals and admissions and utilizes the weekly statistical base to analyze the disposition of the referrals. Tracks and trends referrals not admitted to the program. Demonstrates understanding of the ICD-9 and ICD-10 coding process and ensures correct coding of all diagnoses prior to processing the referral.
Maintains knowledge of Medicare, Medicaid, and third party reimbursement requirements and guidelines. Demonstrates knowledge of payor guidelines for all reimbursement sources. Verifies benefits and precert requirements for all commercial insurance clients and begins certification of medical necessity process whenever appropriate.
Educates referral sources regarding hospice care and payment resources/hospice benefit covered/non-covered items/services. Reviews and verifies that admission financial documents have been completed accurately. Works closely with Financial Supervisor assisting with billing functions to ensure that all necessary documentation is completed/received and that all follow-ups have been completed.
Maintains log for all patients requiring insurance case management follow-up and provides updates as needed to continue authorization for services. Provides input to related administrative/computerized systems and monitors the processing of data relating to patient care to ensure compliance with state and federal regulations, organizational policy, accreditation standards, principles of medical documentation and to ensure proper reimbursement.
Reviews documentation of direct report staff to ensure timely, complete and accurate documentation. Provides appropriate follow up for staff with late or incomplete documentation. Regularly audits and monitors the content of documentation to ensure documentation is done in accordance with standards for medical documentation and that clinical outcomes are being achieved.
Reviews staff email communications (and other types) on a daily basis and addresses any issues identified. Ensures direct report staff are adequately informed of changes in organizational policy, procedures and processes and that necessary information is disseminated to all reporting staff. Ensures that Physician orders are properly taken, completed and documented and are components of the plan of care.
Develops and maintains the database to ensure that orders are accepted only from licensed Physicians. Ensures current licensure for all ordering Physicians in accordance with organizational policies and procedures. Reviews and updates database routinely.
Maintains proof of licensure on all new Physicians, ensures that all Physicians are updated, and collects other Physician information as required by the regulations. Checks routinely for providers excluded from participating in the Medicare/Medicaid programs. Monitors and manages expenses related to direct report staff, medications, supplies, hospitalization and transportation costs.
Monitors staff productivity to ensure compliance with financial/budgetary targets and standards of the organization. Adjusts staffing accordingly. Monitors medication, DME and supply costs ordered at time of referral and admission and approves expenses outside the formularies or other approved arrangements.
Coordinates continuous care, GIC and respite levels of care for patients who meet criteria within staffing constraints. Identifies and implements opportunities for cost savings and efficiencies. P Participate in professional and community health and welfare activities.
Participates in outreach activities to educate public and referral sources concerning hospice and palliative care. Provides education to con