REPORTS TO: CM Supervisor
LOCATION: Allegiance office or off-site
FSLA STATUS: Hourly
_Applicants do not have to reside in Montana._
POSITION RESPONSIBILITIES:
This position assists with the evaluation of medical care alternatives for cases of illness, injuries or medical/surgical diagnoses that require extensive services. The role of the LPN CM Case Coordinator is to coordinate referral requests and to promote high quality care by applying clinical acumen and the appropriate application of policies and guidelines to referral requests for services outside of ACM. This role of the LPN is to facilitate quality health care by decreasing fragmentation, enhancing the patient’s quality of life, while containing costs, resulting in more effective outcomes. The role will also serve as a support when screening for case management services and may be responsible for the liaison to steering to disease management programs.
The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and be respectful and courteous in the conduct of this position
ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.
- Completes clinical assessment and determines who may qualify for case management based on clinical judgment, changes in members health and triggers from assessment
- Able to screen claims triggers for case management needs
- Is the SME for referrals to specialized client vendor partners (this role is assigned on an individual basis to meet the needs of established client specific policies and procedures).
- Pre and post care planning on surgical admissions
- Facilitates discharge planning follow up calls and screens for and initiates referrals for chronic care management program
- Able to effectively initiate and return telephone messages independently, as evidence by individual compliance with Quality Assurance (QA) requirements.
- Provide accurate information to callers as evidenced by software entry/documentation.
- Compliance with protocols and QA requirements.
- Able to function as training preceptor as evidenced by completion of trainee checklist.
- Participates in team meetings, committees, or committee assignments as evidenced by:
- Completion of tasks assigned by team or committee.
- Completion of team QA evaluation in compliance with QA protocol; and
- Knowledge to present and participate in provider/subscriber and group services, workshops, and educational seminars.
- Review letters daily
- Preparation of forms, faxing, copying.
- Organization of files and reference materials.
- Ability to operate typical office equipment and working knowledge of basic office practices.
- Contributes to daily workflow with regular and punctual attendance.
NON-ESSENTIAL JOB FUNCTIONS:
- Performs related or other assigned duties as required or directed.
PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sitting: 80%
Reaching: Minimal
Standing: 10%
Manual Dexterity: Ability to type/keyboard
Walking: 10%
Telephone: High Degree
Kneeling: As needed
Computer Screen: High Degree
Bending: As needed
Lifting: 25 pounds
JOB SPECIFICATIONS:
To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Licensure:
- Current licensure as a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN).
- At least one year experience
- Must maintain all licensure credentials
Other Experience:
- Must possess organizational skills and the ability to prioritize multiple tasks, attention to detail and follow through to completion.
- Excellent oral and written communication skills required.
- PC skills, including Windows and Word. Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication. Must be able to adapt to software changes as they occur.
- Excellent listening skills.
- High level of interpersonal skills to work effectively with others.
- Ability to organize and recall large amounts of detailed information.
- Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations.
- Thorough knowledge of claims processing procedures and requirements.
- Ability to project a professional image and positive attitude in any work environment.
- Ability to comply with privacy and confidentiality standards.
- Ability to be flexible, work under pressure and meet deadlines.
- Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
- Ability to operate typical office equipment.
- Working knowledge of general office procedures
Allegiance Benefit Plan Management, INC is an Equal Opportunity Employer. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: [email protected] for support.