Care Coordinator RN - Remote Position

eQHealth Solutions; Tampa (FL); On-site; USD 52,000 - 78,000; Full time

Job summary

eQHealth Solutions in Florida is seeking a care coordination professional to manage recipient care plans, perform utilization reviews, and coordinate home health services in accordance with contract requirements.

The role includes documenting assessments, coordinating with guardians and healthcare teams, and ensuring timely communications and updates to the Plan of Care. Strong collaboration and community resource skills are essential.

Responsibilities

• Performs care coordination for recipients eligible for home health services.
• Approves/validates utilization review (UR) or forwards to 2nd level reviewer.
• Completes prior authorizations in a timely manner.
• Conducts an initial survey to recommend appropriate home health assessment.
• Conducts home and/or PPEC visits as needed.
• Schedules initial face-to-face meeting in the recipient's home and/or PPEC with the recipient and guardian.
• Assesses, plans, implements, monitors and evaluates the required services.
• Documents assessment findings, actions, and outcomes.
• Documents all communications and follow-up tasks in the Care Coordination System within 1 business day.
• Identifies patient care issues and makes recommendations.
• Collaborates with parent/guardian and healthcare team to arrange identified home care needs.
• Maintains regular monthly contact with recipient and guardian to update Plan of Care.
• Participates in multidisciplinary team meetings to develop a comprehensive plan of care.
• Evaluates and modifies the plan of care and communicates changes to all parties.
• Monitors caseload eligibility status monthly per MMIS.
• Completes Staffing Tool (Freedom of Choice) when a guardian seeks SNF placement reconsideration.
• Follows guidelines for SNF transitions to community settings for six months.
• Functions as a resource to the community.

Job description

• Performs care coordination services for assigned recipients who are eligible for home health services (Home Health Visits, PPEC, Personal Care Services and/or Private Duty Nursing Services etc. based on contract requirements).
• Uses discretion to approve/validate UR or forward to 2nd level reviewer. Provides first level utilization review for all inpatient and outpatient services requiring authorization: Prospective Review Urgent/ Non-urgent, Concurrent Review and Retrospective Review.
• Completes prior authorizations as appropriate in a timely manner.
• Conducts an initial survey to recommend appropriate (home health assessment) for the recipient, unless this has already been done during the current fiscal year
• Conducts a home and/or PPEC visit as needed or if contract requirement
• Schedules and convenes initial face-to-face meeting in the recipient’s home and/or PPEC comprised of the recipient (if able) and the parent or legal guardian.
• Assesses, plans, implements, monitors and evaluates the options and services required to meet the recipient’s health care needs.
• Documents recipient’s assessment findings, actions, and outcomes.
• Documents all communication, interventions and follow up tasks in the Care Coordination System within one (1) business day of each intervention and/or encounter.
• Identifies patient care issues and makes recommendations on patient care issues.
• Collaborates with the parent or legal guardian and healthcare team to arrange for identified home care needs.
• Responsible for maintaining regular monthly contact (telephonically or face-to-face) with the recipient and the recipient’s parent or legal guardian.for purpose of updating Plan of Care (POC), resolving issues and identifying additional issues
• As part of the multidisciplinary team, regularly meets with the team and contributes to the development of a comprehensive plan of care based on the needs of the recipient and recipient’s parent or legal guardian.
• Evaluates and modifies recipient’s the plan of care as needed. Regularly communicates changes to the recipient’s parent or legal guardian, healthcare team, and other agencies involved in the recipient’s care.
• Monitors assigned caseload eligibility status on a monthly basis, based on their status in MMIS.
• Completes a Staffing Tool (Freedom of Choice) any time a parent or legal guardian expresses the desire to reconsider a recipient’s placement into a Skilled Nursing Facility
• Follow guidelines for additional required calls and visits for Skilled Nursing Facility (SNF) transitions to community settings for six (6) months.
• Functions as a resource to the community.