Clinical Care Coordinator - RN (Remote within Florida) Template FL UM/CM

Acentra Health, LLC•UNAVAILABLE, Florida

6d•Remote

About The Position

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the company’s mission, actively engage in problem-solving, and take ownership of your work daily. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. As a Clinical Care Coordinator RN, you will play a pivotal role in ensuring seamless care coordination and advocacy for patients enrolled in the care management program. In this role, you will act as a trusted patient advocate, facilitating immediate communication between patients and providers to ensure timely access to necessary care and resources. Leveraging your clinical expertise, you will conduct comprehensive medical record reviews, applying appropriate criteria in alignment with contract requirements. Utilizing critical thinking and sound decision-making, you will assess medical necessity while maintaining productivity goals and quality assurance standards. Additionally, you will ensure compliance with NCQA, URAC, and other regulatory guidelines, contributing to the highest standards of patient care. To qualify for this role, you must reside and work remotely from the state of Florida. Work Schedule: Monday through Friday, 8:00 AM – 5:00 PM Eastern. Occasional travel (up to 5% annually) within the State of Florida may be required. Access to a dedicated, private, and secure workspace at home, free from distractions, to ensure productivity and confidentiality. Access to reliable, high-speed internet service.

Requirements

Must have an active, unrestricted Registered Nurse (RN) Florida state license and/or Compact State Clinical license.
2+ years of pediatric experience, demonstrating expertise in pediatric care.
Graduate of an accredited Associate, Bachelor’s, Master’s degree program or a Diploma in Nursing.
Valid driver’s license with a clean Motor Vehicle Record (MVR) and reliable transportation for up to 5% annual travel within the state of Florida.
Strong clinical assessment and critical thinking skills, enabling effective patient evaluation and care coordination.
This role requires fingerprinting for the state of Florida.

Nice To Haves

Proficiency in computer systems, including care management applications, internet-based tools, and Microsoft Office (Word, Excel).
Experience in medical record abstracting, ensuring accurate and efficient data retrieval.
Knowledge and familiarity with public sector health coverage systems (e.g., Medicare/Medicaid).
Knowledge of current Utilization Review Accreditation Commission (URAC) standards and compliance requirements.
Knowledge of National Committee for Quality Assurance (NCQA) standards and best practices.
Excellent verbal and written communication skills, ensuring clear, professional interactions with patients, providers, and stakeholders.
Comprehensive understanding of care management principles, ethics, and service delivery standards.
Solid prioritization and organizational abilities, managing workload efficiently while maintaining high-quality standards.
Knowledge of customer service principles, ensuring a patient-centered approach to care.
Proficient telephonic interviewing skills, enabling effective assessments and engagement.
Ability to accept and apply feedback professionally, continuously improving performance and productivity.
Familiarity with medical record organization, medical terminology, and disease processes, ensuring accuracy in case review and documentation.

Responsibilities

Ensure the responsible and comprehensive delivery of services to enrollees, supporting high-quality patient care.
Conduct initial assessments for supervisor/lead evaluation to determine appropriate case manager or health coach assignments.
Actively participate in interdisciplinary team meetings, collaborating on assessments and care coordination to ensure optimal patient outcomes.
Proactively contribute to quality management program activities, supporting the Health Services team in delivering high-performance outcomes.
Assist in achieving and maintaining accreditations for designated programs by ensuring compliance with regulatory standards.
Provide education, guidance, and resources to beneficiaries, families, and providers to promote informed healthcare decisions.
Review and interpret patient records, applying established criteria to assess medical necessity and appropriateness of care.
Determine approval or escalate cases to a physician consultant when necessary, ensuring all decisions—including denials—are clearly documented with sufficient rationale.
Accurately abstract and document case data and medical information using appropriate review tools in a timely manner.
Ensure the accurate and timely submission of all administrative and review-related documentation to the appropriate parties.
Conduct ongoing reassessments of the review process, identifying opportunities for improvement and implementing necessary changes.
Build and maintain positive, professional relationships with internal and external stakeholders to facilitate effective care coordination.
Stay up to date by attending training sessions and scheduled meetings, applying the latest policies and procedures in clinical reviews.
Maintain strict confidentiality of medical records by adhering to HIPAA regulations, using secure systems, and safeguarding sensitive information.
Utilize professional communication—both verbal and written—following Acentra Health's policies, procedures, and guidelines.
Actively cross-train to support other contracts within the Acentra Health network, ensuring a flexible workforce that adapts to client and consumer needs.
The list of responsibilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary.