Care Coordinator - can be RN, LPN or MSW Join to apply for the Care Coordinator - can be RN, LPN or MSW role at eQHealth Solutions .
Job Responsibilities Perform care coordination services for assigned recipients eligible for home health services, including Home Health Visits, PPEC, Personal Care Services, and Private Duty Nursing, based on contract requirements.
Use discretion to approve or validate Utilization Review (UR) or escalate to a second-level reviewer. Provide first-level authorization for inpatient and outpatient services requiring approval, including Prospective, Urgent/Non-urgent, Concurrent, and Retrospective Reviews.
Complete prior authorizations promptly.
Conduct initial surveys to recommend appropriate home health assessments unless already completed within the current fiscal year.
Perform home and/or PPEC visits as needed or required by contract.
Schedule and lead initial face-to-face meetings with recipients and their guardians in their homes or PPECs.
Assess, plan, implement, monitor, and evaluate care options and services to meet healthcare needs.
Document assessment findings, actions, and outcomes accurately.
Record all communication, interventions, and follow-up tasks in the Care Coordination System within one business day.
Identify patient care issues and recommend solutions.
Collaborate with families and healthcare teams to arrange necessary home care services.
Maintain regular contact with recipients and guardians to update care plans, resolve issues, and identify additional needs.
Participate in multidisciplinary team meetings and contribute to developing comprehensive care plans.
Modify care plans as needed and communicate changes to all stakeholders.
Monitor caseload eligibility status monthly via MMIS.
Complete Staffing Tools for requests related to Skilled Nursing Facility placements and transitions to community settings, following guidelines for six months post-transition.
Serve as a resource to the community.
Additional Details Seniority level: Entry level
Employment type: Full-time
Job function: Other
Industries: IT Services and IT Consulting
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