Referral Management Nurse

Visiting Nurse Association of Boston

Position Description

 

 

Position Title: Referral Management Nurse   Dept: Referral Management

 

Reports To:  Manager of Central Intake    Grade: N Scale (Non-MNA)

LPN Scale

 

Supervise:  N/A   Job Code:  980  

Purpose of Position: Receives calls made to the Agency relating to patient referrals ensuring they are handled in a professional and appropriate manner to obtain essential clinical information for admission to the Agency.  Handles inquiries made regarding Agency services and reimbursement/services offered by other community agencies.  Obtains prior approvals for Managed Care Cases, authorizes use of United Way Funds for uninsured patients, maintains log and enters into Horizon. 

 

Accountabilities:

 

1. Receives patient referral calls and records appropriate information regarding patients' medical and social status for admission and input to system; requiring communication with outside agencies to coordinate complicated referrals.  (45%)  E

 

2. Identifies complex cases that meet criteria for evaluation, and forwards to District Directors and communicates process to referral source.  (10%)

 

3. Communicates with district staff to respond to questions or problems with referrals and to coordinate services.  (10%)  E

 

?  Works closely with the Liaison Nurse, Specialty Programs, hospital staff, and Infusion Companies exchanging vital information for coordination of admission or the resumption of services for current patients and to identify reimbursement.

?  Triage referrals to specialty programs for admission and to obtain necessary information for clinical decision and reimbursement.

?  Communicates with Quality Improvement, and Patient Accounts Department, in response to problems regarding reimbursement.

 

  4.  Identifies primary care MD and any related specialty.  Confirms MD who will oversee patient plan of care.  (10%)

 

5. Identifies and obtains prior approvals for Managed Care referrals, uninsured referrals, Brigham and Women's Grant referrals, responds to problems and questions regarding initial approvals, and prepares logs in accordance with guidelines.  (%)  E

 

6. Performs on-call and extended hours rotation as assigned.  (5%)

7. Acts as Instead for Director of Referral Management.  (5%)  E

 

8. Performs other duties as assigned and complies with all policies and procedures of the Agency and other regulators.  (5%)

 

?  Attends departmental and committee meetings.

?  Participates in activities that enhance self-competence and the agency?s performance

  improvement program.

 

Educational/Professional Requirements: Licensed Practical Nurse, Registered Nurse, one year community health experience, Bachelor of Science preferred.  Excellent verbal and written communication skills.  Knowledge and ability to work with AS400 and Personal Computers.  Ability to work in a technology driven system.

 

Physical Demands:

 

3.  Sitting;  4.  Lifting (0-25lbs);  5.  Carrying;  10.  Stooping;  14. Reaching; 15.  Handling;  16.  Fingering; 

18.  Talking;  19.  Hearing;  21.  Near acuity; 22.  Far acuity;  25.  Color vision; 

27.  Coordination of eye / hand / foot controls.