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Skills
Contract Requirementsunmatched
Cross-Functionalunmatched
Healthcareunmatched
Home Careunmatched
Identify Issuesunmatched
Legalunmatched
Needs Assessmentunmatched
Nursingunmatched
Options Analysisunmatched
Organizational Skillsunmatched
Outpatient Careunmatched
Patient Careunmatched
Personal Careunmatched
Problem Solving Skillsunmatched
Registered Nurse (RN)unmatched
Time Managementunmatched
Treatment Planunmatched
Utilization Managementunmatched
Description
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 requirement
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.
Assesses, plans, implements, monitors and evaluates the options and services required to meet the recipient’s health care needs.
Documents recipient’s assessment findings, actions, and outcomes.
Documents all communication, interventions and follow up tasks in the Care Coordination System within one (1) business day of each intervention and/or encounter.
Identifies patient care issues and makes recommendations on patient care issues.
Collaborates with the parent or legal guardian and healthcare team to arrange for identified home care needs.
Responsible for maintaining 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
As part of the multidisciplinary team, regularly meets with the 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.
Monitors assigned caseload eligibility status on a monthly basis, based on their status in 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
Follow guidelines for additional required calls and visits for Skilled Nursing Facility (SNF) transitions to community settings for six (6) months.