In-Home Care Caregiver FULL TIME DAY SHIFTS

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care.

It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do - in the health of our patients, our loved ones, and our community.
Full-Time Benefit Eligible
Work Shift
Day - 10 Hour Shift (United States of America)
The Care Coordination Specialist works in collaboration with RN Case Management (CM) staff to gather clinical data to monitor quality and effectiveness of patient care. Acts as a liaison between RN CM and insurance companies by transmitting clinical data for review. Required: Two years of college or equivalent training/experience in health-related field
Required: Utilization review and/or coding experience
Must understand basic medical terminology.
Excellent communication and interpersonal skills, with the ability to interact effectively with patients, families, and healthcare professionals.
Ability to work collaboratively with interdisciplinary team members and healthcare professionals.
Strong computer skills, with proficiency in electronic medical record documentation preferred. Proficient in using Excel for documentation.
Reviews and records utilization review data for assigned caseload in a manner to ensure all inpatient records are current.
Refers to Case Management team any variances that relate to concurrent review of the medical record. During chart review, is aware of criteria for quality variances. Complies with Kaweah Health Policy by reporting utilization variances to Case Management Committee and/or the P.I. Reviews medical records for admission and continued stay utilizing InterQual Severity of Illness and Intensity of Services for appropriateness of the admission and continued stay. Must also review all cases transferred in and out of special/intensive care areas using specific criteria. Informs the Case Management Team and attending physician of any questionable or denied cases resulting from the review of the onsite Medi-Cal reviewer, CMRI or private insurance companies. Initiates further action by following guidelines set forth in the Hospital Case Management Plan.
Facilitates and coordinates placement of patients in appropriate long-term care facilities.
Facilitates arrangements for acute transfer to other acute facilities when indicated.
Assists case management team with discharge planning services that can include coordination of equipment, home care, home health, and transportation services.
Participates in Continuum of Care rounds.
Accumulates information on community resources and links patients, families and staff to appropriate services.
Answers the telephone, screens calls and takes messages as appropriate, per hospital protocol.
Responsible for all clerical aspects of utilization review including, but not limited to, processing of referrals, input of authorizations into the system, mailing of referrals and attendance at Case Management meetings. Maintains & manages all health plan benefit databases in the system and updates as needed. Takes telephone requests for authorizations. Documents authorizations in SoftMed and Invision. Coordinates the denial appeal process in conjunction with management/RN supervision, including but not limited to writing and/or calling appeals to private insurers and Medi-cal. Coordinates the input of registrar data and provides assistance to the RN Admissions Coordinators in placement of patients and physician communication. Cross-trains in various functions as designated by management including but not limited to acute care, surgery, transitional care, registration, mental health, and acute rehab coverage.

HOME HEALTH:

Responsible for all clerical aspects of utilization review including, but not limited to, processing of referrals and input of authorizations in the system. Communicates with patient and appropriate administrative and patient accounting personnel throughout the process. Communicates with unit staff, patient and case management concerning special wound supply needs/equipment of patient to be admitted to home health. Assures all intake information is complete and accurate including patient information (phone number and address) physician information (name, address, phone and fax number) and insurance information. Inputs all necessary data into the intake system accurately and timely. Notifies patient's PCP of home health referral prior to accepting referral to assure PCP is willing to follow and sign for home health services.
Coordinates patient pick up from the medical units, transports patients to and from the discharge lounge, to waiting vehicles, or assists patients to the restrooms as needed.
Responsible for data collection of patient information, arrival time to the lounge, duration of stay, and medication delivery from the outpatient pharmacy.
Assists with the coordination of medication delivery to the discharge lounge, including working with pharmacy and nursing staff to ensure timely and accurate delivery of medications.
Receives patients and orients them to facilities within the lounge such as reading materials, television, refreshments and exit and restroom locations.
Supports the care for patients; ensures safety of patients in the lounge and management of operation issues in the discharge lounge.
Collaborates with interdisciplinary team members to ensure effective communication and coordination of care for patients in the lounge, and follows up on the needs of the patients as instructed by Registered Nurses or Discharge LVN.
Communicates effectively with patients and families to ensure understanding and compliance with lounge policies and procedures, and to arrange pick up times.
Serves as the primary point of contact for all incoming and outgoing transfer requests, direct admissions, physician admissions, and patient placement inquiries.
Collects comprehensive clinical, demographic, insurance, and financial information required to facilitate patient acceptance.
Communicates with insurance companies regarding authorization status, level of care determinations, and medical necessity documentation.
Completes Medical Necessity Certification Statement for Ambulance Transport
Participates in training of all newly hired Care Coordination staff. Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.