The RN Supports Coordinator (SC) uses person-centered principles to perform comprehensive assessments to determine health care, social needs of applicants, and eligibility for the MI Choice Waiver Program. Assess medical, functional, psychological, financial, and environmental needs of applicants. Coordinates support services to assist participants in developing and monitoring a person-centered long-term care (LTC) plan. The SC will be expected to cover multiple counties of the MI Choice program area as needed. Models AgeWays’ mission and values.

Duties Include:

• Conducts dual discipline in-person RN assessments for the purpose of evaluating MI Choice Program eligibility. Assessment tools per contract of iHC and NFLOC. Identify resources, organizations that may meet the participants' needs. Actively participate in linking and coordinating the participants to needed services and LTC strategies/resources. Conduct monitoring contact calls for participants.

• Facilitate person-centered planning that is focused on the participant’s preferences. Includes family and other allies as determined by the participant, identifies the participant’s goals, preferences, and needs, provides information about options, and engages the participant in monitoring and evaluating services and supports. Determine gaps in care and develop overall Person-Centered Service Plan (PCSP) in managing participant's needs. Revise the PCSP at the participant’s initiation or as changes in the participant’s circumstances may warrant..

• Demonstrate quality, adherence to department, contract and program standards, compliance through consistent audit outcomes conducted by Quality Specialist, Clinical Manager, and other metrics identified by MDHHS, OIG, CSS Department, CQAR. Maintain accurate records and participant files. Enter necessary information into the established electronic medical record. Participate in peer reviews and quality activities.

• Complete case transfers to another Supports Coordinator as assigned by the Clinical Manager, following an audit of the participant record.

• Develop and maintain cooperative relationships with other participant support systems, and conduct referral and case conferencing activities as needed. Establish and maintain working relationships with physicians, hospital discharge planners, human service providers, home care agencies, Department of Health and Human Services (DHHS), and other referring agencies.

• Participate in all meetings as required for MI Choice Program including in-person and virtual team meetings, trainings, agency-wide meetings, and coaching meetings.

• Other duties as assigned (to view the entire job description, please select the "download" button).

Qualifications

QUALIFICATIONS:

• RN Candidates: Minimum Assoc. or Nursing Degree with current State of MI nursing license required.

• Candidates with Experience: Must have 2-4+ years of experience in clinical assessments or psycho-social assessments including: home care experience and working with a similar target population.

• Experienced candidates will have previously worked in psycho-social assessment or home care and/or worked with a similar target population; volunteer experience also beneficial. Additional experience includes managing a caseload of persons with diverse needs, including telephonic monitoring and knowledge of available community services. Experience working with older adults and adults with disabilities.

• Effective time management skills, including the ability to meet deadlines.

• Strong analytical, critical thinking, and problem-solving skills. Proven ability to foster and maintain open, collaborative, and constructive relationships with co-workers and AgeWays leadership to achieve departmental and operational results.

• Ability to work in a community-based setting, independently with little direct supervision of daily duties.

• Excellent administrative and organizational skills; accuracy and attention to detail; must be competent in Microsoft Office, Outlook and 40wpm typing required. Strong technological and telephonic communication skills.

• Valid drivers license required; will travel within a geographic region utilizing own reliable transportation.

OUR INDUSTRY-LEADING BENEFITS CONSISTS OF:

Choice of 3 excellent next to zero cost Medical Plans including Dental and Vision.

401K - Agency contributes 50% match up to first 6% contribution.

Fitness and Wellness programs.

Excellent PTO package- Minimum 4 weeks accrual for the first year.

Get 10 paid holidays and 3 floating.

Mileage reimbursed for business travel.

Work schedules consist of hybrid, community-based, or office-based.

Our recruiting team would love to hear from you today! Please complete our on-line application and submit your resume for immediate consideration. The Area Agency on Aging 1-B is an Equal Opportunity and Affirmative Action Employer.