ob Title: LVN Care Manager, Interdisciplinary Care Team (ICT)
Reports To: SVP of Care Management
Department: Health Services
Job Summary: LVN Care Managers are responsible for managing high risk, high utilizer, and chronic illness members to promote effective education, self-management support and timely healthcare delivery to achieve the best healthcare outcomes. Reports directly to the the SVP of Care Management. Responsibilities include coordinating members care to improve the quality of care through the efficient use of resources and thereby enhancing quality, cost effective outcomes.
Duties and Responsibilities:
- Ensures that members are enrolled into specialized health care programs (e.g., high utilizer, disease management) following appropriate procedures for identifying, screening, and assessing member needs.
- Provides outreach, education and intervention for members who have excessive utilization patterns that typical care management approaches have not been effective to prevent readmissions.
- Conducts a comprehensive health risk assessment (HRA) and the disease management assessment that is consistent with the member’s complex chronic or comorbid conditions. These assessments include the member’s clinical and psycho-social care needs and addresses approaches to meeting needs either through ACE, the member’s benefits plan or external programs and services.
- Collaborates with providers, and other healthcare team members to facilitate care across the care continuum and to optimize clinical outcomes.
- Develop and implement mutually agreed upon, person-centered care plans that include care opportunities and goals aimed at improving the member’s overall health.
- Evaluates and identifies health care service delivery using clinical knowledge to sequence services such that the member receives care in the setting that best promotes quality and efficiency.
- Strives to meet established standards of LVN Care Manager productivity.
- Ensure documentation meets standard procedures and policies.
- Interacts harmoniously with others, focusing on attainment of organizational goals through a commitment to teamwork.
- Maintains a working knowledge of Medicaid and/or Medicare members who may be experiencing chronic and or complex biopsychosocial needs.
Qualifications/Requirements:
- Strong customer service skills to coordinate service delivery including attention to Members, sensitivity to issues, proactive identification, and resolution of issues to promote positive outcomes for Members.
- Ability to effectively participate in a multi-disciplinary team including internal and external participants.
- Familiarity with basic medical terminology and concepts used in care management.
- Understanding of Medicaid/Medicare Advantage healthcare insurance markets, the Managed Care concept and business operations.
- Effective communication, telephonic and organization skills.
- Computer literacy to navigate through internal/external computer systems, including Excel and Microsoft Word.
Education and Certification Preferred:
- LVN with active unrestricted state licensure.
- Case Management certification preferred.
- 3-5 years acute clinical/surgical experience.
- Bilingual skills in Spanish a plus.
- Previous case management experience preferred.
- Managed care organization experience with Medicaid/Medicare and Duals or post-acute and/or Community care experience a plus.
Physical Demands: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Job Type: Full-time
Pay: $19.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Work setting:
Experience:
- Case management: 2 years (Required)
- EMR / Excel: 1 year (Preferred)
License/Certification:
Ability to Relocate:
- Houston, TX 77042: Relocate before starting work (Required)
Work Location: In person