Abode Care Partners

As a member of our Abode Care Partners team, our Clinical Facilitator works closely with our field-based providers to coordinate care for the home-based primary care practice. This position requires strong nursing assessment skills, the ability to identify gaps in care, and provide education. This patient facing position, requires a friendly disposition, and high expectations for follow through on communication, and care coordination

• Builds rapport and trust by providing outstanding customer service to patient/caregiver/facilities and understanding about their physical, social, and emotional needs
• Communicates standing orders to patients/caregiver and health professionals
• Triages incoming phone calls from patient/caregiver/facilities. Receive inquiries from patient/caregiver and assess and documents all conversations/actions/outcomes in the patient chart
• Collect and document objective data, subjective data, and patient care including focused observations such as pain, pain relief, results of treatments, updates to plan of care, implementation, and evaluation of care following charting guidelines
• Process and fax outbound provider orders, including specialist, home health/hospice, laboratory, diagnostics, DME, nutritional supplies referrals. Communicate all orders to patient/caregiver/facility to encourage engagement and participation in their care
• Manage Doctor Alliance portal for assigned providers. Including reviewing incoming orders for compliance, and preparing documents for signature
• Review outstanding orders and provider tracking to ensure services were rendered
• Process pharmacy refills or requests in EHR. Responsible for fulfilling prior authorizations for mediation coverage
• Contributes to the plan of care with input from patient/family and other members of the healthcare team
• Evaluates effectiveness of patient care and the processes for achieving positive patient outcomes
• Monitors and assures the implementation of the Care Plan and participates in Care Management Meetings
• Adheres to standards of the Company's Code of Conduct, policies, Health Insurance Portability and Accountability Act and Corporate Compliance programs and appropriate professional practice standards and applicable state/federal laws
• Attends, participates in and/or conducts internal staff development programs, obtains continuing education as required by Company policy and regulations
• Maintains and enhances clinical practice skills
• Performs other duties, as assigned

• High school diploma/ GED required; Associate degree or some college preferred
• Prefer three plus years of geriatric clinical experience
• Prefer Licensed Practical Nurse/Licensed Vocational Nurse (Compact License desirable)
• Medical Assistant with five or more years’ experience with geriatric or medical complex patient population
• Demonstrates effective and professional interpersonal, verbal, and written communication skills
• Strong assessment skills
• Able to work independently and as part of a team
• Knowledge of compliance (including clinical records) of all local, state, and federal laws regarding licensure and certification with Home Health Care compliance standards
• Organized and able to function under minimal supervision

Abode Care Partners is a leading provider of integrated medical services caring for individuals from post hospitalization to home in various settings ranging from skilled nursing facilities, assisted living, independent living, group homes, and private homes. We bring quality medical care to seniors, people with complex conditions, special needs, and individuals with intellectual and/or developmental disabilities while increasing quality of life and safeguarding the dignity of those we serve. For more information about Abode Care Partners, visit www.abodecarepartners.com.

USD $22.00 - $25.00 / Hour