HomeSTAR is an end-to-end post-acute offering that manages up to 90-day episodes of care, beginning prior to the patient’s discharge from the hospital, or for elective surgical cases, outreach begins prior to hospitalization. The program optimizes our home-based network, identifies the likely best site-of-care for the patient, manages length of stay (LOS) if a Skilled Nursing Facility (SNF) is appropriate, and reduces hospital readmissions. Our program also coordinates all of the services required for a patient to transition to their home faster and safer, via our network of home health, durable medical equipment and home infusion providers, all of whom are supported by our HomeSTAR care coordination team.
This position utilizes clinical expertise to manages assigned HomeSTAR patients’ transition from acute care setting to the home setting through telephonic outreach to provide teaching methods, combined with facilitating in home health care services to accomplish the goals of the HomeSTAR Program. Position initiates outbound calls to HomeSTAR patients, hospitals, discharge planners, physicians, and home health agency nurses providing education regarding the benefits of HomeSTAR. Engages HomeSTAR patients in the program and administers initial assessments, progress surveys and discharge surveys. Position works closely with the HomeSTAR patient home health agency nurse to facilitate education and adherence to establish health care goals and care plan. Participates in performance and operational improvement activities. Works under moderate supervision.
• Using clinical expertise, reviews utilization information concerning patient care and matches those needs to available care options, within the HomeSTAR Program and specific plan payer criteria.
• Care coordination and facilitation with hospital discharge planners, case managers and hospitalist to obtain HomeSTAR orders for engagement.
• Manages the transition of assigned HomeSTAR patients from acute care setting to the home setting utilizing telephonic outreach and teaching methods combined with facilitating in home health care services to accomplish the goals of the HomeSTAR Program. Case management combined with facilitating home health nursing services.
• Initiates outbound calls to HomeSTAR patients, hospitals, discharge planners, physicians, and home health agency nurses providing education regarding the benefits of HomeSTAR.
• Engages HomeSTAR patient in the program and administers initial assessments, progress surveys and discharges surveys utilizing clinical expertise and judgment. Obtains and reviews home health agency program documentation, medication reconciliations and surveys.
• Manages comprehensive home health needs of the patient while participating in HomeSTAR.
• Documents all interactions, guidance and interventions in CareCentrix applications ensuring documentation guidelines are maintained.
• Facilitates obtaining appropriate home health physician orders for the home care services.
• Makes on-going reauthorization decisions for HomeSTAR patients and issues service reauthorizations for the home care provider based on medical necessity and payer benefit guidelines.
• Contacts referral sources to advise them of referral status. Relays referral status and updates to the assigned health plan case managers.
• Communicates customer service/provider issues to supervisor for logging and resolution.
• Participates in and contributes to ongoing quality assessment/improvement activities, ensures the collection of data for improvement analysis and prepares reports as requested.
• Assists team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
• Participates in implementing / maintaining operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.
• Participates in special projects and performs other duties as assigned.
• Diploma in Nursing/Practical Nursing or the equivalent and LPN/LVN (based on allowable state practice act) licensure in the state(s) of practice required.
• Expertise in Utilization Management and knowledge of URAC standards.
• Broad knowledge of health care delivery/managed care regulations, contract terms/stipulations, prior utilization management/review experience, and governmental home health agency regulations required.
• Excellent negotiation, communication, problem solving and decision making skills also required.
• Required to possess an active license to practice without restrictions.
• Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.
• Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.