Nurse Care Coordinator

Care CoordinatorThis is a work-from-home position with travel required within Cherokee, SC County territory/community. Mileage is reimbursed for travel.The (RN) 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.ResponsibilitiesEssential 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: NoneQualificationsQualifications:A Minimum of three (3) years of recent clinical pediatric experience is required.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.Ability to travel locally with a valid drivers' license and automobile insuranceInitial TB negative test and completion of a TB questionnaire, yearlyCertificates, Licenses, Registration:A Bachelor's degree in a health related field is strongly preferred.Certified Case Management (CCM) Certification is preferredCurrent RN licensure in states where business is conducted.Current BLS certificationCompetencies:Strong organizational, interpersonal and motivational skillsExcellent written and verbal communication skillsDetail orientedHigh level of reasoning and analytical skillsAbility to multi-task and work independentlyComputer Skills:Demonstrated computer proficiency with all Microsoft 365 products, electronic health record (EHR/EMR) systems, clinical data entry, telehealth platforms, 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.Other ResponsibilitiesThis 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 SolutionsMaintains strict confidentiality of client, company and personnel informationDemonstrates a strong commitment to the mission and values of the organizationAdheres to company attendance standardsPerforms other duties as assignedCompletes all annual training assigned by the deadline for completionWill demonstrate successful completion and compliance with all policies and procedures, to be assessed during quarterly performance reviewsCriminal 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.At-Will EmploymentPlease 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 WorkplacePremier 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.ConfidentialityYou 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.HIPAA and Data Privacy ObligationsDue 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.Remote / Hybrid / Flexible Work RequirementsEmployees 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