Care Management – LPN

Remote Opportunity

Monday – Friday EST

PRIMARY FUNCTION

Assist in the development, implementation, and operations of a comprehensive Care Management program to distinguish Pediatric Associates in the market based on demonstrating health care quality, efficiency and interconnectivity for patient care management and coordination in support of the mission, core values, goals, and objectives of Pediatric Associates.

ESSENTIAL DUTIES AND RESPONSIBILITIES

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

• Administers Pediatric Associates Care Management program as it relates to population management initiatives, regulatory compliance, utilization management, discharge/transition planning, and payer relations, and program and staff development.
• Make determination whether a patient needs care and if so, what kind of care. This role will be responsible for providing care advice and directing the patient to the correct specialist, provider, or hospital.
• Implements and monitors the case management program focused on population health management.
• Develops and maintains an integrated clinical care management model that fosters appropriate levels of care and maximizes reimbursement/cost savings.
• Administers care management partnerships with commercial payers and other entities.
• Establish innovative relationships with payers and employers that promote value and expand market share.
• Serves as liaison between across the revenue cycle management departments to coordinate effective information flow related to payer contracts and reimbursement.
• Informs patients regarding general preventative care practices as well as individualized care plans.
• May keep track of and/or update patients’ records, especially electronic records, and must keep current with computer technology, software, security measures, and legislation regarding patient privacy and other issues.
• Monitors changes in a patient’s status and subsequent alterations to the care plan.
• Helps implement measures to improve patient care.
• Reviews utilization practices and facilitates positive changes to patient behaviors regarding their medical care.

QUALIFICATIONS

EDUCATION:

• A bachelor’s degree in nursing or related field or combination of education.
• Experience may commensurate education.

EXPERIENCE:

• Combination of education and experience in care management practice administration and/or managed care.
• Care management experience in managed care industry, physician group practice or health care required.
• Significant knowledge of care management, population health management and operational issues related to payers and networks, physician groups, and health insurance benefit plan designs.

LICENSURE / CERTIFICATION

• Registered Nurse (RN) designation/license or licensed practical nurse (LPN) currently enrolled in an RN program.
• Upon hire, and for the duration of the employment period driver’s license must be active and valid.

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of medical billing and health records maintenance.
• Knowledge of ICD-10, ICD- 9, CPT and HCPCS coding.
• Must have excellent interpersonal and communication skills.
• Must have excellent decision making and problem-solving skills.
• Must be detail oriented and have good analytical skills.
• Knowledge of laws governing the protection of patients’ private health information.
• Substantial experience in managed care business development/financial management/consulting with an emphasis on population health and value-based contracting.
• Excellent clinical skills, operations, and systems administration/analysis.
• Demonstrated experience working effectively with payers, employers, state government, and other external influencers.
• Extensive knowledge of health care delivery, including business planning, operations, and finances, coupled with an ability to effectively respond to elements to drive competitive advantages.
• Knowledge of emerging public health issues, health care inequities, health care financing, and health systems.

TYPICAL WORKING CONDITIONS

• Patient facing
• May rotate working in the office and remote/telework.
• Working in a professional office environment.
• The position involves high & frequent call volumes.
• Environment requires ability to multi-task, communicate clearly & concise, data entry for extended period of times.
• Will require sitting for long periods of time.
• Efficient in handling high volume datasets with accuracy, thinking dynamically to solve complex reporting queries, proficiency with MS Office products including Advanced Excel skills & a minimum of beginner/intermediate MS Access skills.
• Working knowledge of SQL/Oracle database models and analysis.