Intake and Referral Relations

About North Country Healthcare (NCH):

North Country Healthcare is a non-profit affiliation of four medical facilities, Androscoggin Valley Hospital, North Country Home Health & Hospice Agency, Upper Connecticut Valley Hospital, and Weeks Medical Center, located in the White Mountains Region of New Hampshire. NCH includes numerous physicians and medical providers at multiple locations. This leading comprehensive healthcare network which employs hundreds of highly-trained individuals delivers integrated patient care through three community hospitals, specialty clinics, and home health and hospice services. NCH remains committed to the health and well-being of the communities we serve. As a leader in a management position this role emphasizes advancing High-Reliability Organization (HRO) principles, embedding a culture of safety, accountability, and consistent high performance.

POSITION SUMMARY:

The Intake Registered Nurse (RN) is essential in coordinating and initiating care for patients referred to Home Health, Hospice, and Long Term Care services. This role involves conducting accurate and timely clinical reviews of referrals, supporting admission readiness, and acting as a liaison between referral sources, patients, families, and internal teams. The Intake RN ensures preliminary clinical appropriateness, gathers necessary documentation, and facilitates a smooth transition to care, aligned with the agency’s standards and regulatory requirements.

ESSENTIAL QUALIFICATIONS

Education:

· Graduate of an accredited nursing program with an Associate’s or Bachelor’s degree in Nursing.

Licensure:

· Active Registered Nurse (RN) license in the state of practice is required.

· Association* accredited course in Basic Life Support (BLS) (for clinical staff), or Heartsaver CPR AED (for nonclinical staff), and renewal on a regular basis, with up to a three-month grace period after the expiration date.

Skills:

· Strong clinical assessment and critical thinking skills.

· Excellent communication and interpersonal abilities.

· Proficient in EHR systems and Microsoft Office.

· Detail-oriented with strong organizational and time management skills.

· Ability to manage multiple priorities in a fast-paced environment.

Work Experience:

· A minimum of 2 years of clinical experience, preferably in home health, hospice, hospital discharge planning, or care coordination. Willing to train the right candidate.

· Knowledge of Medicare Conditions of Participation, hospice eligibility, and home health regulations is preferred.

ESSENTIAL FUNCTIONS:

1. Conduct timely clinical reviews of all incoming referrals to determine eligibility and appropriateness for home health or hospice services.

2. Evaluate clinical information against Medicare/Medicaid regulations, payer criteria, and agency protocols.

3. Communicate with referring providers, hospitals, skilled nursing facilities, and internal stakeholders to clarify orders or missing documentation.

4. Ensure all required documentation is collected prior to admission, including Face-to-Face (F2F) encounters for home health and Certification of Terminal Illness (CTI) for hospice.

5. Collect physician orders, demographics, health history, medication lists, and insurance verifications.

6. Accurately enter referral and clinical data into the Electronic Health Record (EHR) system.

7. Collaborate with scheduling, intake coordinators, and other departments to ensure seamless care handoff and scheduling.

8. Identify urgent or high-priority referrals and facilitate expedited admission processes.

9. Support nurses and therapists with clinical information to ensure effective service delivery.

10. Assist in scheduling admissions and verifying visit capacity and staffing alignment.

11. Participate in morning huddles and referral review meetings to ensure alignment across teams.

12. Maintain a focus on patient-centered care, ensuring accuracy and completeness of all documentation.

13. Actively participate in continuous improvement processes within the department.

14. Uphold compassion, integrity, and accountability in all interactions.

15. Perform other duties as assigned to support the overall success of the agency.

NON-ESSENTIAL FUNCTIONS

1. Performs additional duties as assigned.

2. Adheres to facility Values, Service Excellence and Standards of Excellence.