Cardinal Health Home Health Care Coordinator in Brentwood, Tennessee

Why naviHealth?

naviHealth is the result of over a decade of dedicated visionary leaders and innovative organizations challenging the status quo for PAC management solutions. We do healthcare differently and we are changing healthcare one patient at a time. How might you ask? By hiring talented clinicians, engineers, analysts, and healthcare leaders to create and utilize cutting edge technology to provide the patient with the best level of care for the right amount of time.

Why is this role critical?

The Home Health Care Coordinator (HHCC) role is to facilitate care coordination and management between the member, the health plan and the member’s home care provider(s). The HHCC reviews for authorization of home health services according to CMS and national recognized guidelines. This position is essential for the communication and approval of the member’s home care benefits as outlined by the health plan.

What you will be accountable for…

  • Understands and applies CMS Chapter 7 for home health.
  • Completes medical necessity reviews for home health start of care visits, recertifications, resumption of care and additional visit requests.
  • Case manages all members that have home health services authorized.
  • Documents health care providers’ requests for authorization for services.
  • Enters information timely and accurately data into designated care management applications.
  • Communicates with ATS and naviHealth Medical Director.
  • Reviews LiveSafe scores from previous settings, if applicable.
  • Reviews member’s record for completeness.
  • Request additional records from health care providers, if needed.
  • Determines how many visits are authorized per nationally recognized guidelines.
  • Reviews health care providers documentation of services performed to determine if services are covered.
  • Communicates with the primary physician, as indicated.
  • Makes additional authorizations as indicated and enters into the case management system.
  • Sends written notifications to home health providers and members. Notifies the health care provider of denials reviewed by the Medical Director.
  • Collaborates with all providers, member and member’s medical power of attorney to establish an optimal and individualized care plan.
  • Assist the member in meeting their short and long-term goals.
  • Completes the NOMNC and coordinates with the agency the processing of the NOMNC.
  • Communicates with health care providers and member, naviHealth’s role and provides information on prevention of re-hospitalization.
  • Reviews monthly/quarterly reports, acute re-admissions, and other reports as needed to identify opportunities for improvement.
  • Keeps up to date on national recognized criteria Utilization Management and CMS home health regulations.
  • Attends naviHealth meetings as requested.
  • Adheres to organizational, departmental and regulatory policies and procedures.
  • Keeps updated on NCQA and URAC standards of practice. Promotes a positive attitude and work environment.
  • Performs all other duties as assigned.

What you will need to be successful…

  • Registered Clinician is a requirement of the role with preference for RN, PT, OT or ST credentials.
  • For RN’s, an Active Nursing license in the state in which performing services.
  • Current active unrestricted clinical license required.
  • Bachelor’s degree or equivalent work experience required.
  • 3-5 years’ experience in geriatric care management in a home health setting required.
  • 2 years acute care setting preferred.
  • At least 2 years’ recent experience in case management or utilization management role.
  • Excellent written skills and oral communication skills to complete the role telephonically.
  • Case management experience preferred.
  • Knowledgeable of InterQual and Milliman.
  • Knowledgeable with NCQA and URAC standards a plus.
  • Independent problem identification/resolution and decision-making skills.
  • Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
  • Detail oriented.
  • Proficient with Microsoft Office applications including Outlook, Word, Excel and Power Point.
  • Self-starter with the ability to prioritize daily work load.
  • Excellent documentation skills required.
  • Able to use various office equipment, such as: e-fax and telephone system.
  • Must be proficient in Medical Terminology.
  • Knowledgeable of ICD-10 coding.
  • Knowledge of Medicare reimbursement guidelines for home health.
  • Interested internal candidates must be approved by current clinical manager as a high performing professional requiring minimal direct supervision (as evidenced by chart audits/reviews, interrater reliability results and direct observation).
  • Ability to communicate with Clients and team members including use of cellular phone or comparable communication device.
  • Ability to sit for extended time periods.
  • Ability to work long hours with telephonic communication.
  • Ability to travel occasionally if business needs arise.

The nice to haves…

  • Certification in case management (Commission for Case Management Certification (CCMC); Association of Rehabilitation Nurses (ARN) preferred.
  • Wound care experience preferred.

About Us

naviHealth partners with health plans, health systems and post-acute providers to manage the entire continuum of post-acute care. We utilize evidence-based protocols to optimize care and bundled payment methodologies to align all stakeholders. The result: optimized care and outcomes, reduced inpatient days, reduced hospital readmissions, and increased patient satisfaction.

naviHealth Values

We care about the people we serve.

We care about each other.

We care about our communities.

We embrace innovation.

We like simple.

naviHealth ™ is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.