Care Coordinator II
Reference Code: 4898
Position Title: Care Coordinator II
Location: Remote, Richmond, VA, 23173
Duration: 3 months contract with possible extension
Target start date: 4/5/2021
· Candidates must live in Richmond, VA, and surrounding areas within a 25-mile radius.
· Candidates need to have an RN with 2+ year experience and CPR certification, valid driver’s license with reliable transportation.
· Must have Virginia RN certification/license, CPR certified.
· Day to day responsibilities include – clear and prompt documentation of calls to assigned Nursing Facilities, members and/or member's responsible parties for monthly outreaches, when DMAS restrictions are lifted for the state applicant will be responsible for entering Nursing Facilities to complete Face to Face assessments, complete DMAS documents as needed, proficiency in Skype, Teams, Microsoft outlook and Excel, aiding other population teams as needed including outreaches, telephonic HRAs and manual reports
· Responsible for the assessment and review, coordination, and distribution of review decisions for members identified with medical, surgical, and long-term care, needs including home and community-based waiver recipients. Interacts with Medical Directors, HCS department staff, various other staff and providers and practitioners to ensure timely receipt of decisions in accordance with policies, procedures, and processes.
· Adheres to the company/department’s confidentiality and HIPAA compliance programs. Adheres to the company/departments fraud and abuse prevention/detection policies and programs.
· Provides various care coordination activities in collaboration with the clients managed care organization (MCO), health care providers, other HCS staff, involved medical case managers/care coordinators, public agencies, and other providers as required. Documents all findings, contacts, and interventions.
· Maintains case-specific communication with state agencies, healthcare individuals and support systems to promote efficient and well-coordinated quality care.
· Provides scheduled assessment and review of health needs, individualized care plans, and monitoring of Medicaid eligibility.
· Confers with appropriate staff, including, but not limited to, case managers/care coordinators, medical directors, social workers, health care providers and practitioners, and state agency staff to provide timely and accurate service authorizations and reviews based on a recipients current needs/functioning.
· Communicates review decisions and prior authorizations to various professionals involved in the client’s care, including practitioners and primary care providers (PCP).
· Shared responsibilities for professional responses to client, provider and practitioner, and state agencies via telephone.
· Assists other department team clients when needs are identified. ? Establishes and maintains professional rapport with providers, clients, public agencies, and others involved in the clients’ care.
· Must have strong oral and written communications skill to ensure accurate exchange of information and to build rapport that will ensure the trust, confidence, and cooperation of others in a work situation.
· Must have the skills to learn and adapt to company policies and procedures as they relate to hospital authorization/denials, physician review, appeals, etc.
· Must have the ability to successfully apply established guidelines and regulation to individual and specific situations.
· Must have excellent organization skills to establish and maintain a variety of records necessary to provide complete and accurate information and documentation for relevant and appropriate medical determination.
· Ability to perform independently and to handle multiple projects simultaneously.
· Must have excellent interpersonal skills.
· Must be PC literate (Microsoft Office) and able to work in multiple database/systems simultaneously.
· Excellent verbal and written communication skills
· Ability to abide by policies.
· Maintain regular attendance based on agreed-upon schedule.
· Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
· Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers Required.
· Education: Bachelor’s Degree in a health care related field (Relevant experience will be considered in lieu of degree).
· Required Experience: 2-4 years clinical experience or equivalent combination of education and experience.