On-Site Care Coordinator (RN) - Spartanburg, SC

CHS•Spartanburg, SC

10d•Hybrid

About The Position

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. This is a work-from-home position with travel required within Spartanburg, SC county. Mileage is reimbursed for travel.

Requirements

Licensure as a Registered Nurse in the State of SC.
A Minimum of three (3) years of recent clinical pediatric experience is required.
Ability to travel locally with a valid driver's license and automobile insurance.
Initial TB negative test and completion of TB questionnaire, yearly.
Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook.
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).
Complete HIPAA training upon hire and annually thereafter.
Maintain the confidentiality of all proprietary and non-public information obtained during your employment.
All company property and materials must be returned upon separation of employment.

Nice To Haves

A Bachelor’s degree in a health-related field is strongly preferred.
Previous work experience with a Medicaid program is preferred.
Bilingual (Spanish) is preferred.
Certified Case Management (CCM) Certification is preferred.

Responsibilities

Perform an initial medical eligibility assessment to determine eligibility for the program.
Perform an initial, in-home, level of care assessment to include the completion of all required documentation.
Fulfill 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.
Ensure the information contained in the system of record is accurate and complete.
Provide members and their authorized representatives with education required to care for members and arrange appropriate education services, if necessary.
Develop case-specific care plans/service plans and present to the primary care provider for approval and/or revision; submit care plan to DHHS for approval.
Collaborate with the Care Advocate Team to ensure all required services, communications, documentation, and ancillary needs are addressed.
Maintain 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.
Address and identify complaints, grievances, or concerns and escalate to the appropriate stakeholder, when necessary.
Develop disaster plan, identify 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.
Access and manage PHI in accordance with federal and state requirements (HIPAA, HITECH).
Adhere to the policies and procedures of South Carolina Solutions.
Maintain strict confidentiality of client, company, and personnel information.
Demonstrate a strong commitment to the mission and values of the organization.
Adhere to company attendance standards.
Perform other duties as assigned.
Complete all annual training assigned by the deadline for completion.
Demonstrate successful completion and compliance with all policies and procedures, to be assessed during quarterly performance reviews.
Maintain good standing with Criminal background, OIG, and South Carolina Exclusion list checks.
Complete South Carolina Law Enforcement Division Check upon hire and every 5 years thereafter.
Abide by the Ethical Code of Conduct set forth by the company, to be reviewed and signed yearly.