Overview:
This is a work-from-home position with travel required within Lancaster, SC county.
Mileage is reimbursed for travel.
Position Summary:
The On-site Care Coordinator is a Registered Nurse who provides care coordination, education and outreach services on-site (various locations including home) to Medicaid members in the Medically Complex Children’s Waiver program. This position requires licensure as a Registered Nurse in the State of SC.
Responsibilities:
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Upon referral, perform an initial medical eligibility assessment to determine eligibility for the program. If qualified, perform an initial, in-home, level of care assessment to include the completion of all required documentation.
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Fulfills requirements established by SCDHHS to complete an annual home visit, three in person quarterly visits, and monthly contact calls during months a visit is not required. Ensuring the information contained in the system of record is accurate and complete.
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Provides members and their authorized representatives with education required to care for members and arranges appropriate education services, if necessary.
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Develops case specific care plans/service plans and presents to the primary care provider for approval and/or revision; submits care plan to DHHS for approval.
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Collaborate with the Care Advocate Team to ensure all required services, communications, documentation, and ancillary needs are addressed. Maintains availability to members, their authorized representatives, and providers to coordinate any required services.
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Serve as a member advocate, attending educational advocacy meetings, team conferences, etc. as requested and available. Addresses and identifies complaints, grievances, or concerns and escalates to the appropriate stakeholder, whens necessary.
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Develops disaster plan, identifies availability of advanced directives, needs for ancillary services, specialty services and community services.
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Upon member ineligibility, age out, or other circumstance in which disenrollment from the program becomes necessary, complete all needed activities to ensure continuation of care and communicate with all stakeholders to ensure an uninterrupted transition of care.
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Serve as a mandated reporter
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Will have access and manage PHI in accordance with federal and state requirements (HIPAA, HITECH).
Supervisory Responsibilities: None
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Strong organizational, interpersonal and motivational skills
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Excellent written and verbal communication skills
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Detail oriented
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High level of reasoning and analytical skills
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Ability to multi-task and work independently
Qualifications:
Qualifications:
Education and/or Experience:
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A Minimum of three (3) years of recent clinical pediatric experience is required
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A bachelor’s degree in a health-related field is strongly preferred
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Previous work experience with a Medicaid program is preferred
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Bilingual (Spanish) is preferred
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Ability to travel locally with a valid drivers’ license and automobile insurance insurance
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Initial TB negative test and completion of a TB questionnaire, yearly
Certificates, Licenses, Registrations:
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Certified Case Management (CCM) Certification is preferred
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Current RN licensure in states where business is conducted
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Current BLS certification
Computer Skills:
Proficiency using software programs such as MS Word, PowerPoint, Excel, Outlook and Adobe
Environmental Factors/Physical Demands:
Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and sustained visual attention to monitors. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.
HIPAA and Data Privacy Obligations:
Due to the nature of this position and its involvement with the Medically Complex Children’s Waiver Program, you will have access to Protected Health Information (PHI) governed by the Health Insurance Portability and Accountability Act (HIPAA) and other applicable federal and state privacy laws.
This role has direct access to Protected Health Information (PHI). The following rules are non-negotiable:
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Absolute confidentiality: Employees must not disclose PHI to unauthorized individuals under any circumstances.
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Secure environment: A private, locked workspace must be maintained to prevent exposure of PHI to family members, visitors, or others.
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Company-approved technology only: All work must be performed on secure, company-issued devices using encrypted connections (VPN required).
You will be required to complete HIPAA training upon hire and annually thereafter. Any breach of confidentiality or unauthorized disclosure of patient information may result in disciplinary action up to and including termination and may carry legal consequences under state or federal law.
Other Responsibilities:
This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change at any time with or without notice.
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Adheres to the policies and procedures of South Carolina Solutions
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Maintains strict confidentiality of client, company and personnel information
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Demonstrates a strong commitment to the mission and values of the organization
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Adheres to company attendance standards
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Performs other duties as assigned
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Completes all annual training assigned by the deadline for completion
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Will demonstrate successful completion and compliance with all policies and procedures, to be assessed during quarterly performance reviews
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Criminal background, OIG, and South Carolina Exclusion list checks must remain in good standing
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South Carolina Law Enforcement Division Check must be completed upon hire and every 5 years thereafter
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Will abide by the Ethical Code of Conduct set forth by the company, to be reviewed and signed yearly
At-Will Employment (South Carolina):
Please note that employment in South Carolina is at-will, and either you or CHS may terminate the employment relationship at any time, with or without cause or notice. Nothing in this letter creates a contract for continued employment.
Drug Free Workplace Program:
Premier Family of Companies and its affiliates is committed to providing a safe, healthy, and productive work environment for all employees. To achieve this, CHS maintains a smoke-free and drug-free workplace. Candidates who receive a conditional offer must complete a pre-employment drug screen. Random and post-incident testing may also be required.
You agree to maintain the confidentiality of all proprietary and non-public information obtained during your employment. This includes, but is not limited to, company records, financial data, client and vendor information, business strategies, and any other information not generally known outside the Company. You may not use or disclose such information during or after your employment, except as required in the performance of your duties. All company property and materials must be returned upon separation of employment.
Title: Care Coordinator
Reports to: Director of Care Coordination
SBU: Community Health Solutions of America
Status: Exempt/Salaried – Full-Time
Location: Remote – SC
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