On-Site Care Coordinator; RN - Cherokee County, SC)

Care Coordinator

This is a work-from-home position with travel required within Cherokee, SC County territory/community. Mileage is reimbursed for travel.

Summary:

The (RN) 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.

Essential Duties and Responsibilities:

• 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 necessary.
• 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 care.
• Serve as a mandated reporter.
• Will have access and manage PHI in accordance with federal and state requirements (HIPAA, HITECH).

Supervisory Responsibilities:

None

Qualifications:

• 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
• Initial TB negative test and completion of a TB questionnaire, yearly

Certificates, Licenses, Registration:

• A Bachelor's degree in a health related field is strongly preferred.
• Certified Case Management (CCM) Certification is preferred
• Current RN licensure in states where business is conducted.
• Current BLS certification

Competencies:

• 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

Computer

Skills:

Demonstrated computer proficiency with all Microsoft 365 products, electronic health record (EHR/EMR) systems, clinical data entry, telehealth platforms, Medicaid documentation and care management platforms, and the ability to efficiently navigate multiple electronic systems while maintaining accurate, timely, and compliant clinical documentation in accordance with state and regulatory requirements.

Environmental Factors/Physical Demands:
This position is primarily performed from a remote home office and requires periodic travel to patients' homes and other assigned locations. The employee is responsible for maintaining a professional, safe, and secure home workspace with reliable high-speed internet access that supports the secure handling of confidential and protected health information (PHI). Employees are responsible for providing and maintaining their own home office furniture and workspace.

While performing the essential functions of this position, the employee will regularly use a computer, telephone, and other office equipment; communicate with patients, caregivers, providers, and team members through various electronic platforms; and enter, retrieve, and maintain…