Purpose of Position
The Home Care Utilization Assistant provides the initial and continuing image of the VNA's excellent customer service and will promote the coordination of care of VNA patients. The Home Care Utilization Assistant will ensure that patients receive maximum benefit and quality of services in the most cost-efficient manner. This position is an integral part of the team and will facilitate and enhance teamwork and communication between the Clinical Team Managers, Home Care Utilization Navigator, clinicians, patient/families, and other departments which will promote the financial integrity of the agency as well as optimal outcomes for VNA patients and their families.

Description

1. Work closely with the Clinical Team Managers and the Home Care Utilization Navigator in the following:

a. Ensure all clinicians on team consistently meet productivity expectations.
b. Visit utilization/coordination of patient-centered care.
c. Coordination/scheduling of IDTs.
2. Review initial admission information to provide required clinical documentation to
providers for authorization, utilization, and payment.

1. Tracking of medical documents for commercial insurances and Medicaid to ensure patient schedules and authorizations are compatible.
2. Continually provides managed care organizations with clinical documentation to comply with payer' requirements to obtain reimbursement.
3. Follows through in a timely manner to request/obtain service authorizations per the insurance defined procedures.
4. Processes reconsiderations and appeals of denials for service as appropriate. Review ongoing retroactive reimbursement issues.
5. Maintains updated managed care/reimbursement manuals.
6. Interprets agency policies and criteria for service to insurers, fiscal intermediaries, patients/families, physicians, and the public.
7. Ensure compliance of home health aide (HHA) supervisions when HHAs are referred on certified home care patients.
8. Ordering of supplies for patients/field staff.
9. Organizes and monitors skills checklist of clinicians on team.
10. Maintain knowledge of JCAHO and DPH regulations as well as agency policies and procedures.
11. Communication with patients to discuss and collaborate schedule of certified nursing, therapy, and medical social work visits.
12. Notifies client/family of schedule changes.
13. Scheduling of all clinicians in the team to ensure they meet their daily productivity expectations.
14. Controls and monitors schedule changes and works closely with the team to ensure efficient and coordinated high quality patient care.
15. Fielding phone calls emails, etc. from clinicians regarding their schedules.
16. Daily collaboration with Clinical Team Managers, Home Care Utilization Navigator, paraprofessional department, and clinicians to promote high-quality patient-centered care.
17. All other duties as assigned.

Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects VNA's commitment to CARES: compassion, accountability, respect, excellence and service.

Qualifications

• High school graduate or equivalent required.
• General knowledge of home care preferred.
• Some knowledge of insurance authorization/utilization process for home care preferred.
• Outstanding customer service and interpersonal skills.
• Must work well in a team setting which will promote the quality and efficiency of the team which positively impacts patient-care.
• Exceptional time management and organizational skills.
• Ability to perform detailed work independently without constant supervision in a fast paced environment.
• Must demonstrate efficient computer and technology skills.