Examples of Health Home Care Coordinator in a sentence
IV.C.3.a. For beneficiaries who elect to receive health home services, the Health Home Care Coordinator will perform a comprehensive in-person health screening and work with the beneficiary to complete a Health Action Plan within 90 days of the date when the Lead Entity was notified of the beneficiary’s health home eligibility.
For beneficiaries who elect to receive health home services, the Health Home Care Coordinator will perform a comprehensive in-person health screening and work with the beneficiary to complete a Health Action Plan within 30 days of the beneficiary expressing interest in receiving health home services.
Health Home Care Coordinator – Registered nurse, licensed practical nurse, physician’s assistant, or a BSW or MSW prepared social worker hired by the Health Home Care Coordination Organization to directly provide health home services.
Examples of strategies to improve care transitions include: a notification system between the health home and hospitals, nursing facilities, and residential/rehabilitation facilities to provide prompt communication of a beneficiary’s admission or discharge; and the active participation of the Health Home Care Coordinator in all phases of care transition, including in-person visits during hospitalizations or nursing home stays, post-hospital/institutional stay home visits, and telephone calls.
Health Home Care Coordination Organization – Sub-contracted to the Health Home Lead Entity and responsible for the delivery of health home services through the use of a Health Home Care Coordinator.
For beneficiaries who elect to receive health home services, the Health Home Care Coordinator will perform a comprehensive in-person health screening and work with the beneficiary to complete a Health Action Plan within 90 days of the date when the Lead Entity was notified of the beneficiary’s health home eligibility.
Assignment: Whenever possible, the Contractor shall assign Health Home Beneficiaries to one of its subcontracted CCOs or internal Health Home Care Coordinator using a smart assignment process that takes into account the Beneficiary's preferred provider(s).
The Contractor shall ensure the Health Home Care Coordinator identifies, refers, and facilitates access to relevant community and social support services that support the Beneficiary’s health action goals.
The Health Home Care Coordinator shall develop and execute cross-system care coordination activities to assist Beneficiaries in accessing and navigating needed services.
The Contractor must ensure the Health Home Care Coordinator provides Comprehensive Care Management interventions that recognize and are tailored to the medical, social, economic, behavioral health, functional impairment, cultural, and environmental factors impacting the Beneficiary’s health and health care choices.