RN Care Coordinator - Charleston, SC
This is a work-from-home position with travel required within Charleston, SC.
Mileage is reimbursed for travel.
RN Care Coordinator 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.
Essential Duties and Responsibilities:
- 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.
- 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.
- Provides members and their authorized representatives with education required to care for members and arranges appropriate education services, if necessary.
- 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.
- 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.
- 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, when necessary.
- Develops disaster plan, identifies availability of advanced directives, needs for ancillary services, specialty services and community services.
- 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.
- Serve as a mandated reporter.
- Will have access and manage PHI in accordance with federal and state requirements (HIPAA, HITECH).
Supervisory Responsibilities: None
Qualifications
Competencies:
- Strong organizational and interpersonal skills
- Excellent written and verbal communication skills
- Attention to Detail
- Ability to multi-task and work independently
- Professionalism & Integrity
- Time Management & Organization
- Patient/Client Focus
Education and/or Experience:
- A Bachelor’s degree in a health related field is strongly preferred.
- A minimum of three (3) years of Pediatric Nursing, Pediatric Home Care experience is premium
- Certified Case Management (CCM) Certification is preferred
- Current RN licensure in states where business is conducted.
- Current BLS certification
Certificates, Licenses, Registrations:
- Current RN licensure in states where business is conducted.
- Certified Case Management (CCM) Certification is required. Other certifications recognized by URAC are also acceptable.
- Current BLS certification
Computer Skills:
Demonstrated computer proficiency with Microsoft Office, electronic health record (EHR/EMR) systems, Medicaid documentation and care management platforms, and the ability to efficiently navigate multiple electronic systems while maintaining accurate, timely, and compliant clinical documentation in accordance with state and regulatory requirements.
Environmental Factors/Physical Demands:
This position is primarily performed from a remote home office and requires periodic travel to patients' homes and other assigned locations. The employee is responsible for maintaining a professional, safe, and secure home workspace with reliable high-speed internet access that supports the secure handling of confidential and protected health information (PHI). Employees are responsible for providing and maintaining their own home office furniture and workspace.
While performing the essential functions of this position, the employee will regularly use a computer, telephone, and other office equipment; communicate with patients, caregivers, providers, and team members through various electronic platforms; and enter, retrieve, and maintain information in multiple electronic health record (EHR) and Medicaid documentation systems. The position requires prolonged periods of sitting, keyboarding, and viewing computer monitors.
Periodic travel is required to conduct patient home visits and attend meetings or training as assigned. The employee must be able to safely operate a motor vehicle, enter and exit patient residences, and occasionally navigate uneven walkways, stairs, or other environmental conditions encountered during home visits.
The position may require standing, walking, bending, reaching, kneeling, stooping, and lifting or carrying materials and equipment weighing up to thirty (30) pounds. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position.
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:
- Absolute confidentiality: Employees must not disclose PHI to unauthorized individuals under any circumstances.
- Secure environment: A private, locked workspace must be maintained to prevent exposure of PHI to family members, visitors, or others.
- 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.
- Adheres to the policies and procedures of South Carolina Solutions
- Maintains strict confidentiality of client, company and personnel information
- Demonstrates a strong commitment to the mission and values of the organization
- Adheres to company attendance standards
- Performs other duties as assigned
- Completes all annual training assigned by the deadline for completion
- Will demonstrate successful completion and compliance with all policies and procedures, to be assessed during quarterly performance reviews
- Criminal background, OIG, and South Carolina Exclusion list checks must remain in good standing.
- South Carolina Law Enforcement Division Check must be completed upon hire and every 5 years thereafter.
- Will abide by the Ethical Code of Conduct set forth by the company, to be reviewed and signed yearly.
Remote / Hybrid / Flexible Work Requirements
Employees working remotely and accessing Company systems or Protected Health Information (PHI) must meet the following minimum requirements:
- Reliable, high-speed internet service capable of supporting Company applications and video meetings.
- Hotspots, public Wi-Fi, or unsecured wireless networks are not permitted while performing work involving Company systems or PHI.
- A private, secure workspace where confidential conversations and information cannot be viewed or overheard by unauthorized individuals.
- Ability to maintain compliance with all HIPAA, Company confidentiality, and information security policies.
- Company-issued computer and equipment must be used for all Company business unless otherwise authorized in writing.
- The remote workspace must be password protected and physically secure when unattended.
- Employees must lock their computer whenever stepping away from their workstation.
- Printed documents containing PHI should be avoided whenever possible. If printing is necessary, documents must be secured and properly destroyed using an approved shredder or secure disposal method.
- Family members, roommates, visitors, or other unauthorized individuals may not access Company equipment, systems, or confidential information.
- Employees must immediately report any lost, stolen, or compromised equipment, passwords, or suspected security incidents.
- Employees must comply with all Company cybersecurity requirements, including multi-factor authentication (MFA), password standards, software updates, and antivirus protection.
- Employees are responsible for maintaining a workspace that is safe, free from distractions, and suitable for productive work during scheduled working hours.
- Employees must be available during their scheduled work hours and maintain regular communication with supervisors and team members.
The Company reserves the right to inspect or request photographs of the remote workspace for purposes of verifying compliance with security, confidentiality, safety, and equipment requirements, when permitted by law and with reasonable notice.
At-Will Employment :
Employment with Community Health Solutions of America (“CHS”) is at-will and does not constitute any promise of permanent or perpetual employment, nor does it constitute a promise of future income. Either you or the Company may terminate your employment arrangement and/or associated terms at any time, with or without cause.
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 Premier Administrative Solutions (“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.
Confidentiality:
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.
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Experience:
- Clinical pediatric: 3 years (Required)
License/Certification:
- RN License South Carolina (Required)
Work Location: Hybrid remote in Charleston, SC (Charleston County)
