REGIONAL CARE COORDINATOR JOB DESCRIPTION

Transcription

1 III. REGIONAL CARE COORDINATOR JOB DESCRIPTION Daily administration of the RFTS Project will be the responsibility of the Regional Lead Agency. Each RLA will provide qualified personnel for the function of Regional Care Coordinator and secretary/clerical support. These persons will operate within the framework of the State RFTS Project policies and procedures. A. DEFINITION This position is directly responsible for the day-to-day operation of the RFTS Project at the regional level. The incumbent oversees and carries out all duties required for the implementation, operation, and management of the RFTS Project components. The incumbent directly supervises the support staff and performance of the support staff s work. The incumbent provides direction to and monitors agencies providing direct services to clients in accordance with project standards and protocols. B. QUALIFICATIONS Regional Care Coordination services will be provided by a registered nurse licensed in the State of West Virginia with at least three years of community nursing experience. This person must have previous supervision and administrative experience. In regions where nursing shortages exist and agencies have documented that the three years of community health experience presents a hardship in recruitment for the Regional Care Coordinator position, the agency may submit documentation of the nursing shortage and a description of their efforts for recruitment for approval to the Right From The Start State Coordinator. In these circumstances in place of the community health experience a nurse with a BSN with community health background and/or a DCC with one year experience can be substituted with the approval of the Director of Perinatal Programs. The RN cannot assume the RCC position until all documentation is received and approved by the RFTS State Office. C. JOB OBJECTIVES 1. Comply with the Right From The Start Project guidelines to administer a regional RFTS system for eligible pregnant women and infants. 2. Provide direction to DCCs, medical providers and other professionals to facilitate the delivery of services to eligible pregnant women and infants. 3. Maintain information systems for risk assessment and client tracking. 4. Provide technical assistance and support for individuals or agencies who provide direct RFTS services. 5. Other duties assigned by the State Coordinator.

2 D. AUTHORITY LINES 1. Responsible to: Regional Lead Agency and the OMCFH Right From The Start Project. 2. Responsible for: a. RFTS Secretary and Clerk. b. DCC and other service providers in provision of care coordination services in compliance with RFTS policy and procedures. E. CHIEF RESPONSIBILITIES 1. Provide project administration, coordination, direction and training to ensure that project goals and objectives are identified, met, and evaluated. 2. Provide project administration and coordination to ensure that project goals and objectives meet funding source requirements of the West Virginia Department of Health and Human Resources. 3. Provide direction for and negotiate appropriate agreement/contracts with identified individuals/agencies to ensure that eligible clients can access medical, health education, and nutrition services. 4. Provide quality assurance of RLA s prenatal and infant charts by conducting an audit each quarter of 10 random prenatal and 10 random infant charts. Audit data should be compiled and retained with the RLA. The RCC will use the RFTS Quality Assurance Form for audit. 5. Implements corrective action for RLA and provider agencies based on quality assurance and utilization review done by OMCFH Monitoring Team for the RFTS Project. 6. Work cooperatively with state RFTS staff to ensure that OMCFH requirements are met. 7. Provides any requested reporting needs to Director of Perinatal Programs. F. RECRUITMENT OF PROVIDERS It is the responsibility of the RCC to recruit qualified health care providers to make available RFTS services to all eligible clients. All RFTS eligible clients will have freedom of choice in selecting a provider of case management services and/or enhanced prenatal care services. OMCFH will endeavor to assure that eligible clients have access to a variety of providers for each service category, recognizing that the shortage of professional services of all types may restrict the range of choice in a particular locality. No eligible client s choice may be limited to

3 a geographic area or particular subdivision of the state. It is the responsibility of the RCC to recruit OB providers in each region. These providers shall contract with OMCFH to assure early access to prenatal care to all clients. These recruitment activities are to be reported monthly to the State Coordinator. G. CERTIFICATION OF RFTS SERVICE PROVIDERS RCCs are responsible for verifying eligibility of agencies that provide direct care to RFTS clients. 1. All RFTS Service Provider agencies that provide direct care to RFTS clients must meet the following criteria: a. Providers must be: 1. A local health department as created in West Virginia Public Health Law, Chapter , , and 16-2A of the West Virginia Code, or 2. A health center as defined by U.S. Public Health Service Act 330, or 3. Other federally qualifying health or community service facility as defined by 42 U.S.C a(1)(2)(b). b. Demonstrates capacity to provide elements of defined service(s) categories: 1. Assessment 2. Care Coordination 3. Enhanced Prenatal Care Services c. Provide sufficient number of qualified staff to meet elements of the defined service(s) categories. *The RCC will verify current licensure or certifications for all DCCs, RNs, RDs, CBEs, and LCSWs who will be providing RFTS services at contract renewal. d. Provides administrative capacity to ensure quality of services in accordance with State and Federal requirements. e. Capacity to document and maintain individual case records in accordance with State and Federal requirements. 2. The Regional Care Coordinator responsibilities to the DCC agencies are to: a. Assist the provider agency with the completion of the original contract, state match form and Medicaid Provider enrollment form (MPE-1). b. Certify the provider as qualified after verifying that the applicant meets the above criteria. c. Send certified (original) contract to the Director of Perinatal Programs for approval. The MPE-1 will accompany the

4 contract as well as the documentation of match status form. Upon approval of a contract, OMCFH will submit the MPE-1, a copy of the contract and match status form to Medicaid on behalf of the service agencies. OMCFH will retain the original contract and will forward a copy to the RCC. The RCC will retain a copy of the approved contract and forward a copy to the provider agencies. Providers may not participate in RFTS until certification and a RFTS Medicaid billing number have been verified by the State Coordinator. The Service Provider Agreement must be approved and a copy kept on file in the State Coordinator s office for each agency, entity or person who will provide the services to eligible RFTS clients. In the event the provider wishes to modify the caseload volume or enhanced services offered during the contract year, the following process must be followed: 1. A revised Service Provider Caseload Projection Worksheet must be submitted to the RCC with requests for expansion of services. 2. The RCC will certify the provider has the personnel needed to expand the caseload/service volume. 3. The RCC will send the revised Service Provider Caseload Worksheet to the State Coordinator. 4. Upon arrival of the revision, the State Coordinator will retain the original worksheet and forward a copy to the RCC. The RCC will retain a copy of the approved request and forward a copy to the Provider Agency. H. RFTS PROVIDER TRAINING INCLUDING, BUT NOT LIMITED TO: 1. Provider Training The RCC will provide the following training to all providers: ie, OB, pediatric, mid level a. Obstetrical Provider administration of PRSI. b. Interviewing techniques. c. Completion of PRSI. d. Correction of errors. 2. RFTS Provider Agency The RCC will provide the following training to all provider agencies: a. Administration:

5 I. PRSI REVIEW 1) Billing instruction 2) Reporting 3) Contract preparation 4) Use of forms and form letters 5) Appropriate HMO policy, where applicable b. Project Standards and Guidelines: 1) Service delivery 2) Community resources for provision of service 3) Completion of RFTS DCC forms and reports 4) Record keeping requirements 5) Standards of care 6) Confidentiality 1. The RCC will review all PRSIs for: a. County of Residence b. Accuracy c. Completion (If incomplete, return to the provider for completion) 2. Data Review (See Chapter 10, Quality Assurance ) a. To make sure all fields of data are completed and content is accurate. 3. Assignment of Clients a. Assigns client to appropriate provider agency. J. TRACKING OF CLIENTS * For those Medicaid-eligible HMO enrollees, follow the HMO guidelines for authorization of services. 1. Tracks client to ensure appropriate care. 2. Reviews tracking at discharge for appropriate care according to the needs identified in the Service Care Plan. 3. Notifies DCC of any code or billing errors. K. COMMUNITY OUTREACH 1. The RCC will work cooperatively with appropriate Bureau for Public Health staff to achieve project objectives. 2. The RCC will negotiate with local agencies providing maternal and infant care to provide services for all eligible RFTS participants to include: a. Promotion of RFTS.

6 b. Coordination of community resources available to assist RFTS clients. c. Provision of in-service education to community agencies. d. Networking with state, regional, and local OMCFH projects. L. REQUIRED MEETINGS 1. RCCs must attend all scheduled monthly meetings with State RFTS staff. 2. Each RCC must have quarterly meetings for DCCs. 3. RCCs will attend any other meetings deemed necessary by the State RFTS staff. M. TIME SHEETS 1. The RCC will maintain an individual time sheet for the administration of RFTS activities. 2. Documentation of time spent in the provision of RFTS administrative service will be documented on the Regional Time sheet (R041a) by approved service codes. 3. Time sheets will be submitted to the Director of Perinatal Programs no later than 35 days after the end of the month s activity. Example: January time sheets are due by March Reimbursement for the administrative RFTS staff will be based on these time sheets. 5. Any time spent in activities other than RFTS administration must be documented on the time sheet. This time spent on other activities must be deducted from the invoice total amount of the RCC s salary.