Care Manager Unihealth

PruittHealth; Blue Ridge (GA); On-site; USD 52,000 - 78,000; Full time

Job summary

PruittHealth seeks a field-based Care Coordinator to streamline referrals and admissions, coordinate services with providers, and drive outreach to community sources. This role involves in-home assessments, paperwork completion, and collaboration with Medical Directors and home health teams to ensure timely, quality patient care.

The position requires an active nursing credential, CPR certification, and a valid driver’s license.

Responsibilities

• Markets their area for awareness of SOURCE and PRN meetings with new PCPs.
• Completes all new admission paperwork for signed forms and in-home assessments.
• Participates in weekly Medical Director meetings and presents all new admits, annual assessments, hospitalizations, home health admissions and discharges, variances, potential discharges, and situations threatening health or function.
• Completes quarterly home visits and quarterly PCP visits with all requirements for each completed.
• Documents variances when a care path goal is not met, detailing action plans and follow-ups.
• Coordinates with outpatient therapy centers, home health agencies, healthcare centers (short term) and rehab; completes skilled care track forms; conducts PRN contacts and home visits; reevaluates service needs and effectiveness.
• Uses own vehicle for travel; completes mileage/time sheets for reimbursement; arranges transportation; participates in record audits; completes annual reassessments in members’ homes; reviews medications for appropriateness.
• Attends trainings, trains new hires as needed, participates in on-call rotation per CMS referrals; communicates with regulatory and DFACS agencies for APS and CPS referrals.

Education

Graduate of a state approved accredited nursing school

Job description

POSITION SUMMARY:

Screens appropriate referral and coordinates admission process. Coordinates services with providers, billing reconciliation. Provides outreach to community referral sources.

ESSENTIAL JOB FUNCTIONS, DUTIES, AND RESPONSIBILITIES:

• Markets their area for awareness of SOURCE and PRN meetings with new PCPs.
• Completes all new admission paperwork for signed forms and in-home assessments.
• Participates in team meetings with Medical Director each week and presents all new admits, annual assessments, hospitalizations, Home Health admits and discharges, repeat variances, People with potential for discharge and actual discharges and situations threatening someone’s health or functional status.
• Completes quarterly homes visits and quarterly PCP visits with all requirements for each completed.
• Completes variances at any given time when a care path goal is not met. Must list the variance plan of actions and must have follow up to resolution or a repeat variance with a new plan outlined. Tracks all hospital/ER visits by completing paperwork, requesting records and communicating with hospitals.
• Coordinates with outpatient therapy centers, home health agencies, healthcare centers (if short term), and rehab by working with their staff and completing skilled care track form. Makes PRN contacts and home visits if needed to assess member needs. Reevaluates member needs for service, level of service and evaluates service effectiveness.
• Uses own vehicle for travel. Completes mileage and time sheets for reimbursement. Arranges transportation as required. Is available for internal record audits as requested. Completes annual reassessments in member’s homes. Reviews medicine for appropriateness.
• Attends trainings when required. Trains new hires as needed. Is available for on-call rotation as designated by CMS referrals. Communicates with regulatory and DFACS agencies for APS and CPS referrals.

Qualifications

• Must have a valid driver’s license and automobile insurance liability.
• Graduate of a state approved accredited nursing school.
• Certified in Basic Cardiopulmonary Resuscitation.

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As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.