About Job

Qualis Home Health Services is searching for passionate, reliable, amazingly experienced, and talented Care Coordinators to join our amazing team of in Northern Virginia and surrounding areas. The Care Coordinator at Qualis Home Health Services is the pillar of support from multiple levels within our office - this is a great opportunity to join a fast-growing company that prioritizes YOU!

We know you have many employment options (and we think that's super cool!). Come work with Qualis Home Health Services to see...

How you can grow your career earning, benefits, family time, and more (within the next 6 months!) with a company that truly cares
Why Qualis employees stay with us waaayyy longer than the industry average (seriously, way longer...and we're just getting started on this journey!)
Why we grew from an idea to one of the fastest and four-time awarded Provider of Choice Award, Employer of Choice, and Leader in Training award recipients (hint: it's because of amazing individuals like yourself)
Why we named our company after our mission

Thanks for reading this far! Here are the job duties and requirements...

Essential Functions Include (but are not limited to):

Referrals

Receive all new referrals to initiate the intake process (intake assessment form)
Process incoming service authorization requests from various non-Medicare payer sources and ensure that such authorizations for service are in place for the first and subsequent episodes of treatment periods.
Conduct relationship- building efforts with various referral sources.
Oversee and maintain referral portal and conduct routine warm calling to convert a referral into a new client.
Oversee all aspects of obtaining service authorizations as well as annual service authorization renewals.
Conduct follow-up calls/emails as necessary with referral sources to ensure authorizations are approved in a timely fashion.

Supervision

Serve as a point of contact of CAREStaff on assigned cases
Communicate, on a routine basis, with various entitites, to maintain smooth relations and to obtain needed information
Serve as the first point of contact for all Client/Family needs.
Collaborate with clinical team of RN's/LPN's to schedule new client and renewal assessments and ninety (90) day routine assessments
Ensure the client plan of care is effectively carried out.
Schedule and conduct bi-annual supervisory spot visits.
Ensure the completion and ongoing maintenance of client files.
Conduct quarterly client file audits.

Administrative

Process authorizations in portals such as WAMS and/or other means with MCO's via email/fax.
Conduct routine insurance verifications of all new and current applicable cases to ensure eligibility of services.
Oversee all aspects of obtaining service authorizations as well as annual service authorization renewals.
Participate in both office and state-wide trainings.
Ensure up-to-date with authorization protocols specifically as it relates to Medicaid Waivers and MCOs
Perform data entry in various internal systems such as Trello as a communicative team tool.
Oversee the scheduling of assigned clients on a ongoing basis.
Perform quarterly chart audits for compliance and quality improvement measures
Coordinate and communicate with PCP's for all Private Duty Nursing (PDN) authorizations to submit and ensure the completion of safety plans and CMS 485 forms etc.
Submit requests for various safety plans as needed from the client/individual's PCP.
Complete all assigned Medicaid Waiver quarterly reports, part V's, etc., and ensure copies are submitted in WAMS.
Participate in ISP meetings (virtual and/or onsite).
Create and maintain weekly and quarterly reports.
Ensure that all new client forms such as the consent for treatment and service agreement are completed (either electronically or manually), and the completed documents are saved electronically or ensure the originals are manually completed and returned back to the office prior to the start of services.

Application Question(s):

Are you familiar with WAMS Portal for Medicaid Authorizations & DMAS website?
Do you have experience w/ obtaining authorizations from various MCO's and Medicaid?

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