Care Coordinator RN: Remote work in Florida

eQHealth Solutions; Jacksonville (FL); On-site; USD 56,000 - 68,000; Full time

Job summary

eQHealth Solutions is seeking a Care Coordination professional to manage assigned recipients requiring home health services. You will perform first level utilization reviews, authorize services, and coordinate comprehensive care plans in partnership with families and healthcare teams.

The role requires conducting initial assessments, documenting findings, and maintaining timely communication to ensure optimal recipient outcomes and compliance with contract requirements.

Qualifications

• Experience in care coordination or utilization review.
• Proven ability to develop and update Plans of Care (POC).
• Strong communication with families, providers and interdisciplinary teams.

Responsibilities

• Performs care coordination for home health and related services per contract.
• Provides first level utilization review for inpatient/outpatient services requiring authorization.
• Completes prior authorizations promptly and accurately.
• Conducts initial assessments to determine home health needs.
• Schedules and conducts initial face-to-face meetings with recipients and guardians.
• Documents assessments, actions, and outcomes in the Care Coordination System within 1 business day.
• Monitors monthly caseload eligibility in MMIS and adjusts care plans accordingly.
• Coordinates SNF transitions back to community settings as required.

Skills

Care coordination

Utilization review

Plan of care

Communication

Tools

MMIS

Care Coordination System

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.