On-Site Care Coordinator; RN - Greenville​/Abbeville, SC

Overview

This is a work-from-home position with travel required within Greenville, SC county, including these cities/counties:

Pelham, SC;
Mauldin, SC;
Simpsonville, SC;
Abbeville, SC; and Greenville, SC Mileage is reimbursed for travel.

Position Summary:

The On-site Care Coordinator is a Registered Nurse who provides care coordination, education and outreach services on-site (various locations including home) to Medicaid members in the Medically Complex Children’s Waiver program. This position requires licensure as a Registered Nurse in the State of SC.

• Upon referral, perform an initial medical eligibility assessment to determine eligibility for the program. If qualified, perform an initial, in-home, level of care assessment to include the completion of all required documentation.
• Fulfills requirements established by SCDHHS to complete an annual home visit, three in person quarterly visits, and monthly contact calls during months a visit is not required. Ensuring the information contained in the system of record is accurate and complete.
• Provides members and their authorized representatives with education required to care for members and arranges appropriate education services, if necessary.
• Develops case specific care plans/service plans and presents to the primary care provider for approval and/or revision; submits care plan to DHHS for approval.
• Collaborate with the Care Advocate Team to ensure all required services, communications, documentation, and ancillary needs are addressed. Maintains availability to members, their authorized representatives, and providers to coordinate any required services.
• Serve as a member advocate, attending educational advocacy meetings, team conferences, etc. as requested and available. Addresses and identifies complaints, grievances, or concerns and escalates to the appropriate stakeholder, when
• Develops disaster plan, identifies availability of advanced directives, needs for ancillary services, specialty services and community services.
• Upon member ineligibility, age out, or other circumstance in which disenrollment from the program becomes necessary, complete all needed activities to ensure continuation of care and communicate with all stakeholders to ensure an uninterrupted transition of
• Serve as a mandated
• Will have access and manage PHI in accordance with federal and state requirements (HIPAA, HITECH).

Supervisory Responsibilities
None

• Strong organizational, interpersonal and motivational skills
• Excellent written and verbal communication skills
• Detail oriented
• High level of reasoning and analytical skills
• Ability to multi-task and work independently

Qualifications:

Education and/or

Experience:

• A Minimum of three (3) years of recent clinical pediatric experience is required
• A bachelor’s degree in a health-related field is strongly preferred
• Previous work experience with a Medicaid program is preferred
• Bilingual (Spanish) is preferred
• Ability to travel locally with a valid drivers’ license and automobile insurance insurance
• Initial TB negative test and completion of a TB questionnaire, yearly

Certificates, Licenses, Registrations:

• Certified Case Management (CCM) Certification is preferred
• Current RN licensure in states where business is conducted
• Current BLS certification

Computer

Skills:

Proficiency using software programs such as MS Word, PowerPoint, Excel and Outlook and Adobe

Environmental Factors/Physical Demands:

Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and visual attention to monitors.

May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.

HIPAA and Data Privacy Obligations:

Due to the nature of this position and its involvement with the Medically Complex Children’s Waiver Program, you will have…