ALWP RN Clinical Care Coordinator - San Diego

POSITION SUMMARY:

The RN Clinical Care Coordinator is responsible for the clinical care coordination of ALWP clients under the Care Coordination Agency (CCA). Care coordination includes identifying, organizing, coordinating, and monitoring services needed by a recipient. The RN Care Coordinator assists waiver recipients in gaining access to waiver services, state plan services and other community resources. The RN Clinical Care Coordinator also acts as the clinical resource for the CCT Program.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The following is a representation of the major duties and responsibilities of this position. The agency will make reasonable accommodations to allow otherwise qualified applicants with disabilities to perform essential functions.

Responsible for the proper completion of all clinical documents required for the State Waiver Program Application as per ALWP and Agency policy.

Conducts assessments using the ALW Assessment Tool, determining each client’s level of care (i.e. tier).Develops Individualized Service Plans (ISPs) using the ALW ISP Form and modifies the ISP as needed.

Monitors service delivery, adhering to the prescribed schedule of client contact. Conducts face-to-face visits or telehealth visits(with approval from supervisor in advance) with clients monthly, and as needed.

Maintains proper charting, progress notes and case records for each enrolled client.

Manages complaints from clients, families or friends.

Reports all signs of abuse or neglect to DHCS and the Ombudsman (if abuse or neglect occurs in an RCFE) or DHCS and APS (if abuse or neglect occurs in PH).Responsible for attending Case Conferences with RCFE’s monthly, or as needed. These meetings are held at the Residential Care Facility.

Evaluates ISP effectiveness through observation of Client’s physical condition and behavior, signs and symptoms of illness, reactions to treatment, and through communication with the Client and health team members.

Reviews Significant Incident Reports (SIRs) with the client and RCFE staff, as necessary.

Serves as the clinical support for the CCA Office Coordinators.

Participates in Education, Training and Quality Improvement Activities for the ALWP. Assists the Agency in maintaining compliance with Federal, State, Local and HIPAA Regulations or Joint Commission Standards.

Establishes and maintains good relationships with RCFE, SNFs and other vendors.

Regularly self-assesses nursing skills and educational needs to meet the nursing care requirements of patients assigned for care.

Driving may be required to geographical areas that are covered by the company.

Maintains a comfortable work environment for all employees.

Maintains proper timekeeping.

Follows policies and procedures as per Employee Handbook.

Maintains all required credentials up-to-date.

Reports fraud and abuse.

Knowledge of mandated reporting.

Conducts timely recording and/or documentation of all client contact.

Attends department meetings (in person, by phone or by web).Attends all state mandated in-service trainings.

Possesses familiarity with Title 22.Performs other duties as assigned.

PHYSICAL REQUIREMENTS:

Stand, sit, talk, hear, and use of hands and fingers to operate computer, telephone, and keyboard on a frequent basis up to 40% of the time.

Reach, stoop, kneel and bend up to 20% of the time Moderate amount of walking up to 15% of the time.

Moderate amount of driving up to 25% of the time.

Close vision requirements due to computer work on a frequent basis

Light to moderate lifting may be required up to 25lbs on a frequent basis.

Pushing and pulling up to 25lbs.

QUALIFICATIONS:

Must have a current, unsuspended, un-revoked license to practice as a Registered Nurse in California.

Knowledge of The State of California Assisted…