MA - Intake Nurse

The Intake Nurse serves as the clinical gatekeeper for new referrals and prospective clients, ensuring patients meet payer, regulatory, agency, and clinical eligibility requirements before admission. This role collaborates closely with referral sources, family growth associates, case managers, business development teams, and clinical leadership to evaluate referrals, assess patient needs, determine service appropriateness, and support timely admissions.

The Intake RN uses clinical judgment to identify patients who qualify for skilled nursing, home health aide, personal care, paid family caregiver, or other agency services while ensuring compliance with state regulations, payer requirements, and agency policies.

This role reports directly to the Director of Nursing for the agency.

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  Review incoming referrals, leads, and prospective patient inquiries for clinical appropriateness.

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  Evaluate medical records, physician orders, diagnoses, medications, treatment plans, and supporting documentation.

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  Determine whether requested services meet agency admission criteria and payer requirements.

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  Assess eligibility for skilled nursing, personal care, home health aide/family caregiver, or specialty programs.

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  Identify clinical risks, safety concerns, and service limitations that may impact admission.

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  Escalate complex clinical cases to the Director of Nursing or Clinical Leadership as needed.

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  Document qualification decisions and rationale for tracking purposes.

• Conduct telephone-based clinical screenings with patients, caregivers, referral sources, and physicians.

• Gather missing clinical information needed to complete qualification reviews.

• Verify functional limitations, care needs, diagnosis history, medication management needs, and caregiver support systems.

• Prioritize referrals based on urgency, acuity, and service availability.

• Maintain timely response times for all incoming leads.

• Verify referrals meet Medicare, Medicaid, managed care, private duty, and agency-specific requirements.

• Ensure physician documentation and orders support requested services.

• Maintain knowledge of state regulations, home health conditions of participation, and payer authorization requirements.

• Assist with prior authorization clinical documentation as needed.

• Collaborate with scheduling and operations teams to coordinate Start of Care (SOC) visits.

• Work with FGAs to communicate admission decisions to referral sources and internal stakeholders.

• Ensure all required documentation is completed prior to admission.

• Support smooth handoff to assigned case managers and field clinicians.

• Monitor referral outcomes and identify trends affecting admissions.

• Participate in intake process improvement initiatives.

• Assist with development and maintenance of admission criteria and clinical screening tools.

• Support quality assurance audits related to intake documentation.

• Active RN license in applicable state(s).

• Minimum 5 years of nursing experience.

• Minimum 1 year experience in home health, hospice, case management, utilization review, intake, or care coordination.

• Strong clinical assessment and critical thinking skills.

• Knowledge of Medicaid, Medicare, and home health regulations.

• Excellent verbal and written communication skills.

• Experience reviewing medical records and clinical documentation.

• Proficiency with EMR systems and Google Office.

• Pediatric home health experience.

• Family caregiver program experience

• Prior authorization or utilization management experience.

• Bilingual capabilities.