Establishes working relationships to provide integrated care between shareholder hospitals, local health care providers, physicians, care coordinators, community representatives, and employees. Maintains open lines of communication within the programs of McLaren Home Health & Hospice. Provides and/or coordinates discharge planning for community contacts regarding home care services from VitalCare. Acts as a resource person for community contacts regarding clinical services, programs and methods of payments. Educates referral sources to home health issues. Facilitates smooth patient transition from acute to post-acute care services.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Collaborates with health care team members, patients and their families to discuss home health needs and available services from McLaren Home Health & Hospice product lines, including Home Health, Special Services, Hospice, Private Duty and Home Medical Equipment.
Identifies, facilitates and coordinates patient care and services for referral sources and shareholder hospital.
Maintains open communication and works collaboratively with employees from all McLaren Home Health & Hospice product lines.
Educates community regarding the scope and goals of home health services, including specifics of covered skilled and supportive care available.
Confers with referral sources to ensure that coverage and eligibility and coverage criteria are met. Initiates indigent care process.
Strives to discern appropriate referrals.
Conducts delivery of physician orders and engages in conversation for the purpose of identifying opportunities for performance and/or process improvement.
Provides recommendations regarding opportunities for improvement identified with physicians, care coordinators, and community contacts.
Discusses options and alternatives with physicians, care coordinators, and community contacts regarding the services of home health care.
Identifies issues regarding system and operational issues that affect the ability to provide comprehensive services for potential and referred home care patients.
Participates in quality assessment and improvement activities when appropriate.
Participates in committee activities, work groups, task forces, etc. for the organization.
Applies program development, concepts and ideas that will serve appropriate community needs.
Participates in developing and accomplishing annual goals and objectives for home care services.
Submits computerized reports as requested.
Maintains a professional network within the community.
Participates in care coordinator meetings at shareholder hospital. Participates in rounds with the care coordinator, and physicians.
Graduate of an accredited school of nursing or other health care profession.
Requires current Michigan RN or other healthcare related license.
Requires one year of home health/clinical experience.
Northern Michigan Hospital