Care Coordinator - RN remote any Florida city Join to apply for the Care Coordinator - RN remote any Florida city role at eQHealth Solutions .
**Responsibilities include:**
Performing 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.
Using discretion to approve or validate Utilization Review (UR) decisions or escalate to a second-level reviewer. Providing first-level utilization review for inpatient and outpatient services requiring authorization, including Prospective, Urgent/Non-urgent, Concurrent, and Retrospective Reviews.
Completing prior authorizations promptly.
Conducting initial assessments to recommend appropriate home health evaluations unless already completed during the fiscal year.
Performing home and/or PPEC visits as needed or required by contract.
Scheduling and leading initial face-to-face meetings with recipients and their guardians in their homes or PPEC facilities.
Assessing, planning, implementing, monitoring, and evaluating care options to meet health needs.
Documenting assessments, actions, and outcomes thoroughly.
Recording all communications, interventions, and follow-ups in the Care Coordination System within one business day.
Identifying patient care issues and making appropriate recommendations.
Collaborating with families and healthcare teams to coordinate home care needs.
Maintaining regular contact with recipients and guardians to update care plans, resolve issues, and identify new needs.
Participating in multidisciplinary team meetings to develop and adjust comprehensive care plans.
Monitoring caseload eligibility monthly via MMIS.
Completing staffing tools when reconsidering placement into Skilled Nursing Facilities and following guidelines during SNF transitions.
Serving 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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