There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
The LVN Care Coordinator coordinates and tracks follow-up services for members post discharge from inpatient setting into the outpatient setting. This position is to act as a liaison for the members to ensure follow-up care is coordinated between the hospital discharge planners, home health agencies, ancillary care facilities, and the treating physicians. Provides follow through of the case management program to ensure members receive appropriate healthcare and will triage new onset medical problems for the PCP to prevent readmissions. Care coordination of post hospitalized patients will provide for coordination of medically necessary services to support the primary care physicians in the delivery of healthcare.
- Coordinates follow-up care appointments and/or assists in directing care to physician clinic nurse or ITC clinic and/or medical services for post-hospitalized patients and assures timely and complete communication to ITC clinics when applicable
- Assesses patients' clinical information and effectiveness of current medical services through phone interview, following either the WellMed or Milliman specified template for the type of call being made
- Investigates and solves problems relating to patient responses indicating continued medical problems, plan of care failures, knowledge deficits and other responses of concern
- Provides health services counseling regarding identified patient knowledge deficits, such as dietary information, medication orders explanation, and rationale for immediate follow up with primary care physician/ITC, etc.
- Provides members with information on how to access services within WellMed including newly identified transportation needs
- Identifies need for non-covered services and provides options for the patient with the assistance of WellMed case manager(s) and/or social worker(s)
- Identifies urgent issues and forwards to the case manager, case manager supervisor, case management manager, or PCP as indicated
- Makes follow-up calls to member as necessary to resolve items identified on initial call
- Notifies case manager if information is obtained indicating the member is using a non-participating or non-authorized provider to allow case manager to investigate and pursue either an LOA for services or to redirect services in plan, or that patient has been institutionalized
- Develops and maintains a network of providers, contacts, staff and other customers who may be able to assist in establishing care with new patient or arranging acute care appointments
- Provides PCP with outpatient care assessment information and documents follow-up and interventions in the Case Management Documentation System (CMDS)
Potential to work from home once training is completed and strong performance is maintained.
- High School diploma or GED
- Current LVN license (specific to state of employment)
- Experience in physician’s office as LVN in back office or hospital floor nurse of medical/surgical bed
- 3+ years of experience that is directly related to the duties and responsibilities specified
- Possess planning, organizing, conflict resolution, negotiating, and interpersonal skills
- Knowledge of legal ethical issues related to patients’ rights, rehabilitation terminology, discharge guidelines, community support services and funding
- Ability to observe, assess and report success of discharge planning
- Strong interpersonal, communication and teamwork skills
- Proficient with Microsoft Office programs including Word, Excel, and ability to learn proprietary programs
- Independent problem identification/resolution and decision making skills
- Associate’s degree
- Understanding of management practices or health plan administration of referral process, triage or medical management
Physical & Mental Requirements:
- Ability to lift up to 10 pounds
- Ability to push or pull heavy objects using up to 25 pounds of force
- Ability to sit for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: LVN, case management, Dallas, Texas, TX, DFW, discharge planning, telephonic