EMPLOYEE EVALUATION Angels Care Home Health

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					               EMPLOYEE EVALUATION/JOB DESCRIPTION
                        Agency/Branch: ________________________________

Employee Name: _________________________                  Date: _____________DOH:_______________
Position: Intake                                             6 Mo_____ Annual ______ Other____

                                                                        25%     50%     75%     100%
Evaluation Part 1:                                                      0 Pts   3 Pts   5 Pts   10 Pts
Maintains Positive Attitude Toward Job Responsibilities and Co-
Workers
Arrives to Work on Time
No Excessive Absences
Can appropriately Answer Questions about Disease Management
Programs
Knowledgeable About Community Resources and Competition
Completes Intake/Referral form in entirety
Checks Medicare Eligibility/HMO Verification for every Referral and
Prior to each Recert
Maintains Professional, Positive Phone Etiquette At All Times
Builds Relationships with MD Office Personnel and D/C Planners
Maintains Information of All Local Home Health Agencies/Payors
Sends Therapy Referrals Timely and Follows Up on Eval Dates
                                                          TOTALS
TOTAL POINTS FOR PART 1: _________

                                                                        25%     50%     75%     100%
Evaluation Part 2:                                                      0 Pts   1 Pt    3 Pts   5 Pts
Observance of Organizational Policies and Procedures
Acceptance of Constructive Criticism/Supervision
Willingness to Accept Additional Assignments
Ability to Manage Time Effectively
Contacts Physician to Obtain Additional Medical Records as Needed
Can Perform Effectively Under Stress
Appropriately Attired/Groomed
Understand HR Handbook
Completes specific tasks delegated by Branch Manager
Obtains clinical information for all OASIS visits
Notifies marketer daily / gives information on all admits/referrals
Maintains Referral Log
Maintains accurate dry erase Admit/Discharge/Hospital boards
Maintains accurate daily documentation for all SOC/ referral dates
Maintains weekly census count and turns in Spindown Report every
Friday to Manager by 1:00 PM, then turns in accurate report to
Corporate by 2:30PM CST each Friday
                                                               TOTAL
TOTAL POINTS FOR PART 2: _____________




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                           EMPLOYEE EVALUATION/JOB DESCRIPTION
                                         Agency/Branch: ________________________________

Employee Name: _________________________                                                   Date: _____________DOH:_______________
Position: Intake                                                                         6 Mo_____ Annual ______ Other______

Page 2

Part 1 Score: _______________
Part 2 Score: _______________




Goals for Improvement:
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____________________________________________________                                  _________________________________________________
Employee’s Signature                                                                  Date

----------------------------------------------------------------------------------------------------------------------------- -----------------------------------

____________________________________________________                                     _________________________________________________
Supervisor’s Signature                                                                   Date of Evaluation

____________________________________________________                                     _______ ___________________________________________
Employee’s Signature                                                                     Date




Rev 12.10                                                                            2

				
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