Care Coordinator RN remote work: Baton Rouge or New Orleans
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Job Responsibilities
- Perform care coordination services for assigned recipients eligible for home health services, including home health visits, PPEC, personal care, and private duty nursing, based on contract requirements.
- Use discretion to approve or validate utilization reviews (UR) or escalate to the second level. Provide first-level authorization review for inpatient and outpatient services requiring approval, including prospective, urgent/non-urgent, concurrent, and retrospective reviews.
- Complete prior authorizations promptly and accurately.
- Conduct initial assessments to recommend appropriate home health evaluations unless already completed within the fiscal year.
- Perform home and/or PPEC visits as needed or required by contract.
- Schedule and lead initial face-to-face meetings with recipients and their guardians in the home or PPEC.
- Assess, plan, implement, monitor, and evaluate the recipient’s healthcare needs and services.
- Document assessments, actions, outcomes, and all communication in the Care Coordination System within one business day.
- Identify patient care issues and collaborate with families and healthcare teams to develop and update care plans.
- Maintain regular contact with recipients and guardians to update care plans, resolve issues, and identify additional needs.
- Participate in multidisciplinary team meetings and contribute to comprehensive care planning.
- Monitor caseload eligibility status monthly and manage transitions, including Skilled Nursing Facility (SNF) placements and community re-integrations.
- Serve as a resource to the community and manage workload related to quality reviews and case follow-ups.
- Prioritize requests and develop cooperative relationships while maintaining confidentiality.
- Provide courteous, prompt service to internal and external customers.
- Attend staff meetings, continuing education, and participate in quality improvement initiatives.
- Assist with special projects and perform other duties as assigned.
Job Details
- Seniority level: Entry level
- Employment type: Full-time
- Job function: Other
- Industries: IT Services and IT Consulting
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