Job description

ESSENTIAL DUTIES and RESPONSIBILITIES:

· 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

KEY COMPETENCY

· 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.

QUALIFICATIONS:

· 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.

Physical and Mental Requirements:

· Ability to safely and successfully perform the essential job functions with or without a reasonable accommodation, including meeting qualitative and/or quantitative productivity standards.

· Ability to maintain regular, punctual attendance.

· Ability to sit for 6-8 hours.

· Constant use of computer keyboard and mouse; repetitive use of both hands.

· Occasional to frequent twisting of neck; occasional bending of neck and at waist.

This job description is not an exclusive or exhaustive list of all job functions that an employee in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced or delegated by management to meet the business needs of HealthComp.

Job Type: Full-time

Pay: $55,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Medical specialties:

• Home Health
• Hospice & Palliative Medicine

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Nursing: 1 year (Preferred)
• Case management: 1 year (Preferred)

License/Certification:

• LVN (Required)

Work Location: Remote

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