Qureos Mentor

Sunshine Homecare Services

<div>RN- Director of Pediatric Services for Licensed Home Health Agency-10K Sign on Bonus

Looking for an environment that values and cares for their employees? Then Sunshine is the Right place for you! Join a team that's like a family - you will enjoy being a part of the Sunshine family!

Sunshine is looking for a full-time RN Director of Pediatric Services for our Licensed Home Health Agency with offices in New City and the Bronx. Our agency has won numerous awards for staff satisfaction and patient care excellence. As Director of Patient Services, you will play an integral role in the agency's daily operations.

Roles and Responsibilities:
<ul>
<li>Manages day-to-day operations of pediatric patient services following the organization's mission, philosophy, and goals.</li>
<li>Participates in short- and long-range planning for the home care program and in measures for program growth.</li>
<li>Participates in the development of the department's budget.</li>
<li>Oversee and manages the execution of quality measures including preparation and participation in all quality initiatives and QAPI Committee meetings.</li>
<li>Provides oversight to ensure that all aspects of home care programs including personnel and patient care services operate within the standards and are compliant with all applicable laws, rules, and regulations.</li>
<li>Oversee the execution of plans for the effective management of deficiencies in new case onboarding, service delivery, and relationship management with patients and their family</li>
<li>Supports the company's various clinical initiatives in areas of new programs, employee on-boarding, orientation, in-service, training, and clinical oversight.</li>
<li>Performs field visits to evaluate nurses and perform nursing visits in times of increased demands or scheduling issues.</li>
<li>Participates in collaboration with the HR department planning, implementing, and evaluating the orientation and continuing education of all staff.</li>
<li>Manages the hiring, training and performance management of staff.</li>
<li>Oversee proactively and recommend updates to all policies and procedures in accordance with the needs and rights of clients and caregivers, and compliance with acceptable standards of practice.</li>
<li>Other duties as assigned.</li>
</ul>
Qualifications:
<ul>
<li>Bachelor's Degree Required, Master's Degree (Preferred) in Nursing Administration, Education, Clinical Specialty, or equivalent field and five years of satisfactory nursing experience, of which three years shall have been in a supervisory or teaching capacity; or a Baccalaureate Degree in Nursing and six years of satisfying nursing experience, four years of which shall have been in a supervisory or teaching position.</li>
<li>Valid NY RN License and fluency in DOH Rules and Regulations and in-depth working knowledge of home care.</li>
<li>Previous experience working with CHHA/LHCSA preferred.</li>
<li>Must have at least 2 years of pediatric clinical experience.</li>
</ul>
 Job Details:
<ul>
<li>Job Location: Onsite &ndash; New City, NY</li>
<li>Schedule: Monday to Friday, 8:30 AM &ndash; 5:00 PM</li>
<li>Salary Range: $130,000 &ndash; $150,000 annually plus 10K sign on Bonus</li>
<li>Employment Status: Exempt</li>
</ul>
Benefits Offered:
<ul>
<li>401(k) Retirement Pension Plan</li>
<li>Tuition Reimbursement</li>
<li>Health Insurance</li>
<li>Life Insurance</li>
<li>Short-Term &amp; Long-Term Disability Coverage</li>
<li>Paid Time Off (PTO)</li>
<li>Vacation Time Accrual</li>
<li>Paid Sick Leave</li>
</ul>
Essential job duties listed indicate the minimum level of knowledge, skills, and/or abilities deemed necessary to perform the job competently. Job descriptions are an overview of the task responsibilities and requirements of the position. Employees may be required to perform other job-related assignments as requested.

Sunshine Homecare Services is an equal opportunity employer. Sunshine Homecare Services is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.</div>

RN Director of Pediatric Services for Home Health Agency

<div><h2 class="jobSectionHeader">Position: Medicaid Eligibility / Authorization Coordinator</h2>

Reports To: Controller

<h2 class="jobSectionHeader">Position Summary:</h2>

At Sunshine Homecare Services, we believe access to quality care begins with compassion, accuracy, and advocacy. We are seeking a dedicated Medicaid Eligibility / Authorization Coordinator who is passionate about supporting patients and families by ensuring uninterrupted insurance coverage and timely authorizations.

This role is vital to our mission, serving as a key liaison between patients, families, payers, and internal teams. The Coordinator ensures that eligibility, authorizations, and compliance requirements are met so our clients can receive care without delay across all Sunshine Homecare agencies.

<h2 class="jobSectionHeader">Qualification:</h2>
<ul><li>
Bachelor's Degree with 3&ndash;5 years of experience in Medicaid eligibility and authorization management within a healthcare setting, including acquiring and maintaining authorizations for Medicaid and other insurance plans.
</li><li>
Knowledge of NHTD and TBI program requirements and regulations is a plus.
</li><li>
Experience working directly with patients, family members, service coordinators, Medicaid representatives, and insurance companies.
</li><li>
Ability to read, write, and comprehend instructions, short correspondence, and memos; ability to draft professional written communications.
</li><li>
Strong verbal communication skills, with the ability to effectively present information in one-on-one and small-group settings.
</li><li>
Proficiency in office equipment and computer applications, including Microsoft Word and Excel.
</li><li>
Strong organizational, interpersonal, and time-management skills.
</li><li>
Ability to apply common-sense reasoning to carry out instructions and resolve routine issues.
</li><li>
Ability to manage standardized processes with occasional variables in a fast-paced environment.
</li></ul>
<h2 class="jobSectionHeader">Contacts:</h2>

External Contacts:
<ul><li>
Patients and patient families
</li><li>
Service coordinators
</li><li>
Medicaid representatives
</li><li>
Insurance companies
</li><li>
Outside billing vendors
</li></ul>
Internal Contacts:
<ul><li>
Administrative staff
</li><li>
Intake team
</li><li>
Finance department
</li></ul>
<h2 class="jobSectionHeader">Equipment Used:</h2>
<ul><li>
Computer
</li><li>
Telephone
</li><li>
Copier
</li><li>
Fax machine
</li></ul>
<h2 class="jobSectionHeader">Specific Duties &amp; Responsibilities (ADA Essential Functions):</h2>

In compliance with the Americans with Disabilities Act (ADA), essential job functions are identified below. A duty is considered essential if the position exists to perform that duty, requires specialized skills, or can only be performed by a limited number of employees.

Confirm patient insurance coverage and eligibility for services prior to admission and before services are rendered.

Obtain initial and ongoing authorizations from Medicaid and insurance companies, ensuring all required documentation is submitted accurately and timely.

Serve as a liaison between patients, families, insurance representatives, service coordinators, and clinical staff to facilitate the authorization process and resolve issues.

Gather and submit all required documentation for patients enrolled in NHTD and TBI programs.

Track patient eligibility status and ensure continuous enrollment to prevent service interruptions.

Submit required documentation to Medicaid for fee-for-service patients, including pediatric cases.

Develop and maintain a tracking system for expiring authorizations, reviewing weekly to prevent lapses that may result in non-payment.

Follow up on outstanding authorization requests to ensure timely determinations and continuity of care.

Provide clear information and support to patients and families regarding insurance coverage and authorization processes, promoting a positive patient experience.

Maintain accurate and compliant records of all authorization requests, approvals, and denials in accordance with regulatory and internal policies.

Perform other duties as assigned by the Controller.

<h2 class="jobSectionHeader">Customer Services &amp; Interpersonal Skills:</h2>
<ul><li>
Assists team members as needed
</li><li>
Demonstrates cooperation and professionalism with patients, families, supervisors, and colleagues
</li><li>
Maintains a friendly, respectful, and professional work environment
</li><li>
Accepts constructive feedback and adjusts performance accordingly
</li><li>
Uses established communication channels effectively
</li><li>
Respects individuals and seeks assistance appropriately when needed
</li></ul>
<h2 class="jobSectionHeader">Specialized Skills &amp; Technical Competencies:</h2>
<ul><li>
Proficiency in ePACES and electronic eligibility systems
</li><li>
Experience with HHA Exchange preferred
</li><li>
Strong telephone and customer service skills
</li><li>
Word processing and spreadsheet management
</li><li>
Accurate data entry skills
</li></ul>
<div>Benefits:</div>
<ul><li>401K Retirement Plan &amp; Employer Matching</li><li>
Health Insurance (Medical, NY STD)</li><li>
Employer Sponsored Flexible Spending Account (FSA)</li><li>
Generous Paid Time Off (PTO) Package</li><li>
<div>7 legal holidays</div>
</li></ul><h2 class="jobSectionHeader">Physical Demands:</h2>

The physical demands described below are representative of those required to perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

Sedentary Work: 
Exerting up to 10 pounds of force occasionally and/or negligible force frequently. This position involves prolonged periods of sitting and extended computer use.

<h2 class="jobSectionHeader">Additional Information:</h2>

Essential job duties listed indicate the minimum level of knowledge, skills, and/or abilities deemed necessary to perform the job competently. Job descriptions are an overview of the task responsibilities and requirements of the position. Employees may be required to perform other job-related assignments as requested. 


Sunshine Homecare Services is an equal opportunity employer. Sunshine Homecare Services is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, contact HRgroup@sunshinecares.com. Joanne DiBiasi of Human Resources at (845) 613-7838 Ext 2213</div>

Medicaid Eligibility/Authorization Coordinator Sunshine Homecare Services

Join Sunshine Homecare Services and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Sunshine Homecare Services

ABOUT_COMPANY

RN Director of Pediatric Services for Home Health Agency

Medicaid Eligibility/Authorization Coordinator Sunshine Homecare Services