Nurse Care Specialist

This is a professional, licensed Registered Nurse position that will ensure the primary, medical care service coordination for dependent children on the Sunshine Health Pathway to Shine Plan and other MMA plans, 72-hour well-child checkups, monitor medical metrics and follow high risk/medically complex children. Essential Functions: Establishes and maintains positive working relationship with HFC internal and external customers Assists in the coordination of medical care for children under dependency court supervision Ensures that an initial Health Risk Assessment is completed on children and submitted to Sunshine Health Participate in staffings for children who have been assessed, recommended or placed in medical foster care, deemed medically complex or fragile, who have ongoing medical or dental needs, which impact their care while in the dependency system. Participate on child specific staffings, attend and facilitate trainings. Report any identified issues to child welfare case management, Sunshine Health or health care plan and places appropriate referrals for medical case management Follows up with case manager and/or caregiver following all emergency and inpatient admissions and document accordingly into Envolve Client portal regarding discharge follow up recommendations and to assess any physical health needs Monitor enrollment status of children and confirm youth is enrolled onto the appropriate health plan Alert HFC’s Resource Specialist when children who receive SSI benefits enter into licensed care Process and submit Care Grants for children while ensuring the application is complete with accompanying documentation Coordinate with REVMAX department in regards to appropriate demographic changes and report any identified Medicaid issues Work closely with Sunshine Health regarding Healthcare Effectiveness Data and Information Set (HEDIS) measures Serves as a consultant to case management on making timely, appropriate and effective referrals to medical care services Assist Children’s Medical Services (CMS) caregivers in obtaining Durable Medical Equipment, locating appropriate providers and specialists. Participates in discharge planning and coordination with health care plan from inpatient services including the monitoring of post-discharge follow-up appointments and ordered services Reviews the health and wellness reports, Florida Safe Families Network (FSFN) reports, Florida Shots, and other data sources for status of required annual physical, dental and vision screenings for children placed in out of home care and coordinate with child welfare case manager and/or caregivers as needed to ensure scheduling of needed appointments Notify Sunshine Health on all pregnant members within 24 hours of discovery and refer for Sunshine Health pregnancy case management. Participate in monthly OB staffings with Sunshine Health Perform and participate in other activities as assigned by Sunshine Health and HFC Completes Sunshine Health TOC (transition of care) document and report any barriers or needs for medical case management Coordinate and support the Central Florida Health Care mobile dental and vision screening services offered to children served by the child welfare system Review care gaps and follow up with caregivers and/or case managers to ensure members are getting their required medical and dental services Completes PCP (primary care physician) changes as needed and provide Medicaid ID cards Obtain medical records to assist with continuity of care and to coordinate with caregivers and/or case managers regarding any additional services or needs Provide education as needed to caregivers and/or case managers regarding medical diagnoses, well exam and immunization schedule Reviews Incident Reports and completes follow up with caregivers and/or case managers as needed Performs special projects as assigned Required Qualifications: Licensed registered nurse.Minimum of two years of nursing experience preferably in the child welfare or behavioral health care setting Excellent benefits package with tuition assistance, domestic partner coverage, retirement andgenerous paid time off. Additional Information: Drug free workplace. Drug testing required. EOE/M/F/D/V. #J-18808-Ljbffr