Case Manager - LPN/LVN

HealthComp

Remote, United States

Now is the time to join us! 

In this role you will wear many hats, but your knowledge will be essential in the following:  

• Telephonically manage cases on a long or short term basis per established Company guidelines, policies and procedures, as well as other standardized criteria in the healthcare industry.
• Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
• Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs.
• Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions.
• Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care.
• Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
• Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis.
• Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports.
• Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information.
• Evaluate and make referral for wellness programs.
• Maintain complete and detailed documentation of case managed patients in Eldorado Quick link, and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30 day intervals ensuring confidentiality according to
• Company policy and HIPAA

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

What you bring to the Personify Health team:

In order to represent the best of what we have to offer you come to us with a multitude of positive attributes including:

• Graduation from an accredited LVN program possession of a current California LVN license.
• Prefer case management experience, emergent room, critical care background or some other area of clinical care that is pertinent to case management.
• Prior experience in case management, coordinating wellness programs, or an equivalent combination of education and experience.
• Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience.

You also take pride in offering the following Core Skills, Competencies, and Characteristics:

• Computer proficiency and working knowledge of Microsoft Office Suite and Microsoft Outlook required.
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding preferred.
• Knowledge of utilization management/quality management case philosophies and reporting requirements; quality improvement methodologies preferred.
• Ability to critically evaluate claims data and provide accurate patient assessment; ability to establish nursing treatment plans.
• Excellent interpersonal and communication skills; strong customer orientation; good time management skills; highly organized.

No candidate will meet every single desired qualification. If your experience looks a little different from what we’ve identified and you think you can bring value to the role, we’d love to learn more about you!

Personify Health is an equal opportunity organization and is committed to diversity, inclusion, equity, and social justice.

In compliance with all states and cities that require transparency of pay, the base compensation for this position ranges up to $27.00 per hour. Note that salary may vary based on location, skills, and experience. This position is eligible for health, dental, vision, mental health and other benefits.

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