Care Coordinator RN - Miami Broward Area

Responsibilities

• Performs care coordination services for assigned recipients who are eligible for home health services (Home Health Visits, PPEC, Personal Care Services and/or Private Duty Nursing Services etc. based on contract requirements).
• Uses discretion to approve/validate UR or forward to 2nd level reviewer.
• Provides first level utilization review for all inpatient and outpatient services requiring authorization: Prospective Review Urgent/ Non-urgent, Concurrent Review and Retrospective Review.
• Completes prior authorizations as appropriate in a timely manner.
• Conducts an initial survey to recommend appropriate (home health assessment) for the recipient, unless this has already been done during the current fiscal year.
• Conducts a home and/or PPEC visit as needed or if contract requirements.
• Schedules and convenes initial face-to-face meeting in the recipient’s home and/or PPEC comprised of the recipient (if able) and the parent or legal guardian.
• Affirms recipient’s health care needs and collaborates with the parent or legal guardian and healthcare team to arrange for identified home care needs.
• Maintains regular monthly contact (telephonically or face-to-face) with the recipient and the recipient’s parent or legal guardian for purpose of updating Plan of Care (POC), resolving issues and identifying additional issues.
• Regularly meets with the multidisciplinary team and contributes to the development of a comprehensive plan of care based on the needs of the recipient and recipient’s parent or legal guardian.
• Evaluates and modifies recipient’s the plan of care as needed. Regularly communicates changes to the recipient’s parent or legal guardian, healthcare team, and other agencies involved in the recipient’s care.
• Maintains regular monthly contact with assigned caseload eligibility status on MMIS.
• Completes a Staffing Tool (Freedom of Choice) any time a parent or legal guardian expresses the desire to reconsider a recipient’s placement into a Skilled Nursing Facility.
• Functions as a resource to the community.

Qualifications

Commensurate with experience.