The Home Health Liaison will primarily receive orders to evaluate a patient from a physician or a member of the Renown Health care team who identifies a patient that has potential for home health services. This liaison must be a Home Health expert that plays a key role in discharge planning and care planning in order to avoid concurrent denial of services. Evaluates the appropriateness and potential for admission based on the referral, patient current and future needs, family requests, discharge plan/support available and third-party payer recommendations. As needed, obtains (and enters into Epic) physician orders for care, completes an in-person clinical assessment for HH appropriateness, completes consents for service with patient/family, helps facilitate safe discharge to appropriate location/level of care. Validates that the patient meets qualifying criteria including ensuring the primary diagnosis is compliant with CMS PDGM guidelines, the patient is homebound, and the patient has a skilled/clinical need. Collaborates with the Home Health Clinical Leadership team and admission team as needed to determine capacity for referral acceptance and ensure timely admission to achieve optimal clinical outcomes. Communicates daily with Case Management in acute care and Coordinators in other post-acute settings through multiple means regarding findings. Utilizes and maintains documentation consistent with Renown Health's Case Management department and the Renown Facility/Service receiving referral. Educates physicians, case managers, social workers, discharge planners, caregivers, patients, and family members as to the availability and benefits of Home Health as determined by CMS/Insurers. Confers continuously with attending physicians, nursing staff, social workers, case managers, and transfer/Intake Coordinators. Demonstrates the knowledge and skills necessary to evaluate for Home Health needs, based upon physical, motor/sensory, psychosocial, and safety appropriate to the age of the patient served. Participates in marketing initiatives both within Renown and with external providers to ensure consistent referral volumes and appropriate patients. The incumbent must be able to evaluate all patients through coordination with the interdisciplinary team, the assessment, planning, implementation, and evaluation of adult and geriatric patients and families. This position does not provide patient care.
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