Health Care Coordinator

Health Care Coordinator (Position Overview)

Aging and Disability Services Division (ADSD) is currently recruiting for a full-time Health Care Coordinator 2 in Reno/Sparks, Nevada. This recruitment may be used to fill current and future vacancies as they occur in the following program:
Office of Community Living. The incumbent will manage an established caseload size of program recipients based on slot allocation and staffing ratios and will manage a caseload of program recipients residing in urban/rural areas. The incumbent will provide case management to program recipients which would include assessing individuals for program services, establishing ongoing services per Person Centered Plan of Cares, monitor program services, assist/refer to appropriate community services.

The incumbent will conduct recipient contact programs using established methods of contact via phone, email and/or in person. Locate and coordinate a network of services and resources to meet the program recipient's health and safety needs. Input program information/data into designated databases in timely manner, complete needed reports to state, county or community entities. Review, respond and/or complete any reports, program inquiries within required time frames.

Communicate any program issues to their supervisor. Attend mandatory training and classes as required.

ADSD fosters a positive, inclusive, and diverse work environment that values innovation, teamwork, and collaboration. The mission of ADSD is to empower individuals and their support systems by providing resources for disabilities and aging - connecting Nevadans to services and improving their quality of life.

Health Care Coordinators perform professional work related to program operations and auditing providers to ensure compliance with program policies and regulations. They evaluate individuals referred to the medical services program and provide ongoing case management services to Medicaid eligible clients.

They evaluate the need for medical services, treatment, equipment and supplies and authorize payment; screen individuals to determine appropriate level of care in nursing homes; review programs to ensure services are being provided in a cost effective manner; participate in program development by providing input on policies and procedures, forms, medical coverage and system enhancements.

They assess potential client needs for case management services using assessment tools to identify social service and/or medical needs; develop and implement plans of care for those determined to be eligible for services; counsel and refer clients to services and/or contract with providers for services; maintain contact with clients through home visits and telephone calls; monitor the quality and cost of services provided to clients;

periodically update plans of care; submit payment authorization requests; and maintain case files.

Participate in periodic reviews of facilities providing care to Medicaid eligible clients to validate and ensure adequacy of services and resident care; ensure reimbursement matches the cost of services provided; monitor nursing facility quality indicator reports; screen and assess Medicaid clients regarding discharge to community-based care; review medical records; document findings and deficiencies on appropriate forms; prepare reports of findings and participate in exit conferences;

participate in independent professional reviews of providers to determine the quality of care, compliance with patient rights, and appropriateness of placement as assigned.

Review health care providers and fiscal agents to ensure clients are receiving appropriate services and payment is correct for services received; ensure providers and fiscal agents are in compliance with division policies and procedures; ensure employee health, certification and training needs are appropriate and properly documented in personnel records; verify client records have appropriate documentation and that authorized services correlate with services provided;

confirm termination of services were appropriately documented and mandated reporting requirements were met; provide technical assistance regarding policies and procedures; complete written documentation using appropriate format; identify areas needing improvement and review plans of correction.

Process payment authorization requests from providers to ensure the requested service, treatment, equipment or supplies are medically necessary and in compliance with Medicaid criteria prior to approving or denying requests; review pertinent medical information and previous requests; evaluate medical necessity to justify payment by comparing the diagnosis and other medical information with the request; refer requests to a medical consultant for another medical opinion as necessary;

render determinations in accordance with Medicaid policy and notify providers of decisions.

Review records from the fiscal agent, providers, clients and computer…