Care Manager Unihealth

Pruitthealth Corporation; Blue Ridge (GA); On-site; USD 60,000 - 78,000; Full time

Job summary

Pruitthealth Corporation in Georgia seeks a registered nurse to coordinate admissions, coordinate services with providers, and manage outreach to community referral sources. The role includes travel, documentation, and collaboration with medical directors to ensure quality care.

The position requires an active nursing license, CPR certification, and a valid driver's license. On-site responsibilities include completing paperwork, home visits, and coordinating with home health teams and therapists.

Qualifications

• Requires licensure and vehicle for travel.
• Nursing degree from accredited program.
• CPR certification required.

Responsibilities

• Market area for SOURCE and PRN meetings with new PCPs.
• Complete new admission paperwork and in-home assessments.
• Participate in weekly team meetings with Medical Director and present new admits and discharges.
• Complete quarterly home visits and quarterly PCP visits.
• Track variances and develop action plans with follow-up.
• Coordinate with therapy centers, home health agencies, and rehab; assess member needs.
• Arrange transportation, track mileage, and support audits.
• Attend trainings and train new hires; participate in on-call rotation.
• Communicate with regulatory and DFACS for APS and CPS referrals.

Skills

Valid driver's license

Auto insurance liability

Education

Graduate of a state approved accredited nursing school

Certified in Basic Cardiopulmonary Resuscitation

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.