LPN, Care Manager

Remote Opportunity

Schedule: Monday - Friday 8am - 5pm EST

Spanish Speaking Required

PRIMARY FUNCTION

The Care Manager, LPN assists in the care coordination for identified medically fragile and complex pediatric patient population. Functions as a liaison between the patient and the care team. Interacts with Primary Care Physician (PCP), front office, outside specialists, health plans, and patients/caregivers. Provides guidance and direction to Chronic Care Coordinators and may provide education to patients.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned.

1. Conducts outbound calls to complete assessments of targeted medically complex pediatric patients. Collaborates with family and patient health care team to identify patient needs.
2. Reviews current plans of care and makes recommendations per current state guidelines for medical necessity. Collaborates with the Medical Director to ensure appropriate service delivery including review of findings, criteria not met, determination of appropriate level of care, delay in services, alternative solutions, etc.
3. Communicates treatment changes to the PCP, family, healthcare team, and others involved in patient care.
4. Assists with coordinating and may participate in multidisciplinary rounds, peer to peer reviews, and individual case reviews for established patients.
5. Participates in quality review processes to ensure active reviews are completed.
6. Completes documentation in the care management platform and electronic health record.
7. Responds to incoming and outgoing correspondence and requirements of plans of care and recertification.
8. Reviews incoming referrals, plans of care, and consult notes. May escalate to the medical director for follow up.
9. Functions as a resource on state requirements for home health guidelines.
10. Participates in ongoing development, implementation, and evaluation of program and process effectiveness. Formulates recommendations for process modifications. Identifies opportunities and recommends methods to improve service, processes, and financial performance.
11. Participates in internal initiatives. Participates in gathering information and data for CMS reporting.
12. Functions as expert resource for staff. Provides guidance and direction to Chronic Care Coordinators and may provide education to patients.
13. Provides courteous and prompt service to all internal and external customers.

QUALIFICATIONS

EDUCATION: Minimum associate degree or two years’ technical schooling in related area required. Combination of education and experience in care management, practice administration and/or managed care will be considered.

EXPERIENCE: A minimum of 3 years previous healthcare experience required functioning as an LPN/LVN,
A minimum of 5 years preferred. Care management experience in managed care industry, physician group practice or health care required.

LICENSURE / CERTIFICATION: Licensure as an LPN/LVN or higher required.

KNOWLEDGE, SKILLS, AND ABILITIES

• Patient management skills
• Strong customer service skills including de-escalation expertise.
• Knowledge of medical billing and health records maintenance.
• Excellent interpersonal and communication skills.
• Excellent decision-making and problem-solving skills.
• Detail oriented and analytical skills.
• Knowledge of laws governing the protection of patients’ private health information.

TYPICAL WORKING CONDITIONS

• Non-patient facing
• Full time remote requires quiet workspace without distractions or interruptions while interacting with patients and caregivers.
• Must be U.S. based.
• Indoor work, operating computer.
• Sitting

OTHER PHYSICAL REQUIREMENTS

• Vision
• Sense of sound
• Sense of touch

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.