I/DD Waiver Registration Coordinator/RN - (Remote within the State of Virginia)

Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.

Position Overview

As the I/DD Waiver Registration Coordinator (RC) and Registered Nurse (RN), you play a pivotal role in authorizing I/DD Waiver services by applying specific criteria and clinical expertise. Your primary responsibilities involve close collaboration with provider agencies to ensure seamless processing of requests, delivering exceptional customer service, technical support, training, and consultation to both providers and contractors.

In addition to managing waiver registrations, your duties include critically reviewing nursing documentation to verify that requested nursing services align with outlined clinical necessities. Working in tandem with provider agencies, you'll gather essential information, such as nursing notes, DD9 forms, and doctor's orders, to facilitate the processing of nursing requests.Your role serves as a crucial link between various stakeholders, utilizing your RC and RN expertise to uphold quality standards and ensure the fulfillment of essential clinical criteria.

Job Responsibilities

• Evaluate I/DD Service Authorization Requests: Responsibly assess and align service authorization requests with I/DD Waiver policy, member needs, interpretive guidelines, and person-centered planning.
• Thorough Medical Assessment for Authorizations: Conduct comprehensive reviews of medical conditions, symptoms, and functional abilities to authorize I/DD Waiver nursing services for consumers in need.
• Efficient Processing of Dual Service Requests: Manage dual service requests and ensure timely processing of I/DD Waiver therapy checks.
• Support Authorization Decisions: Prepare for and actively participate in service denial pre-hearing conferences and hearings, providing integral support throughout negotiation processes, specifically in nursing-related decisions.
• Exception Panel Participation: Regularly attend and contribute nursing recommendations in weekly exception panel meetings for I/DD Waiver LPN and RN Services.
• Exceptional Customer Service and Consultation: Deliver outstanding customer service and consultation to providers and contractors, showcasing exceptional interpersonal, telephone, and negotiation skills to meet program deliverables.
• Utilize Software Tools for Effective Communication: Employ various software tools and web applications to enhance communication and decision-sharing among stakeholders.
• Maintain Confidentiality and Ensure HIPAA Compliance: Uphold stringent confidentiality standards and ensure compliance with HIPAA regulations while evaluating all relevant issues.
• Adherence to Ethical Standards: Demonstrate unwavering commitment to ethical standards in interactions with members, providers, and contractors.
• Stay Updated on Industry Developments: Remain current with industry developments, policy changes, and best practices pertaining to I/DD Waiver services.
• Complete Designated Responsibilities and Cross-Training: Fulfill designated responsibilities and engage in cross-training with other programs as required.

Required Qualifications, Knowledge and Skills

• Education and License: Bachelor's Degree in Nursing with an active, unrestricted RN license in the state of West Virginia.
• Experience with I/DD: Minimum of 2 years of experience working with individuals with intellectual and developmental disabilities.
• I/DD Waiver Program Expertise: Proficient understanding of the current I/DD Waiver program policy manual, with minimum 1 to 2 years of hands-on experience within the WV I/DD Waiver program.
• Communication Skills: Exceptional verbal and written communication skills.
• Customer Service and Organizational Skills: Demonstrated customer service abilities, multitasking proficiency, strong organizational aptitude, and flexibility.
• Proficiency in Software Tools: Strong proficiency in Microsoft software applications and other relevant tools.
• Teaching/Training Ability: Proven capability to teach/train others in person, via phone, or through web-based/interactive technology.
• Professional Demeanor: Consistent maintenance of a professional demeanor in all interactions.
• Proficiency in Microsoft Office: Intermediate proficiency in Microsoft Office products.
• Organizational and Time Management Skills: Strong organizational and time management abilities.

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