Ambulatory Case Management LPN

Carolina Pines Regional Medical Center; Hartsville (SC); On-site; USD 52,000 - 78,000; Full time

Job summary

ScionHealth seeks a Care Coordination professional to oversee patient care across the Interdisciplinary Care Transitions team, ensuring smooth continuum of care and effective resource use. You will follow patients through the care continuum, support plan implementation, and contribute to discharge planning.

The role emphasizes utilization management, collaboration with physicians and payors, and maintaining compliance with regulatory standards while promoting cost-effective care and patient

Qualifications

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Must read, write and speak fluent English.
• Basic computer skills with Microsoft Office, word-processing and spreadsheets.
• Excellent interpersonal, verbal and written communication to collaborate with leadership, payors and staff.
• Must have regular attendance.
• Approximate travel 0%.

Responsibilities

• Care coordination with Interdisciplinary Team and Physicians.
• Assist with care facilitation and resource coordination.
• Keep knowledge current on reimbursement and community resources.
• Refer high-risk patients for additional support.
• Advocate for patients and families.
• Participate in rounds and conferences.
• Collaborate to execute the plan of care and discharge planning.
• Conduct utilization management and medical necessity reviews.
• Support cost-effective utilization of clinical resources.
• Contribute to committee work as needed.

Skills

Payor practices knowledge

Medicare knowledge

Accreditation standards knowledge

Fluent English

Microsoft Office

Interpersonal communication

Verbal and written communication

Regular attendance

Travel 0%

Job description

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

Coordinates and facilitates the care of the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members. Follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with external review agencies. Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs. Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.

Essential Functions

• Care Coordination Assist in coordinating clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians.
• Assists with effective care coordination and efficient care facilitation.
• Remains current from a knowledge base perspective regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care.
• Appropriately refers high risk patients who would benefit from additional support.
• Serves as a patient advocate.
• Knowledgeable of the principles of growth and development over the life span and the skills necessary to provide age appropriate care to the patient population served.
• Participates in interdisciplinary patient care rounds and/or conferences.
• Collaborates with clinical staff in the execution of the plan of care, and achievement of goals.
• Discharge Planning Under appropriate supervision, conducts comprehensive, ongoing assessment of patients and family to provide timely and safe discharge planning.
• Assists with comprehensive discharge planning.
• Utilizes critical thinking to execute effective discharge planning.
• Utilization Management Conducts medical necessity review for appropriate utilization of services from admission through discharge.
• Promotes effective and efficient utilization of clinical resources.
• Conducts timely and accurate clinical reviews, care collaboration and coordination of continued stay authorization with payor.
• Other Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
• Serves on Hospital and Division committees when requested.

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Knowledge of accreditation standards and compliance requirements.
• Must read, write and speak fluent English.
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software.
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.
• Must have regular attendance.
• Approximate percent of time required to travel, 0%.
• Performs other related duties as assigned.