Clinical Liaison, LPN

Davita Inc.; Somerville (MA); Hybrid; USD 55,000 - 75,000; Full time

Job summary

A leading healthcare provider is seeking a Licensed Practical Nurse (LPN) for their iCMP Plus program in Massachusetts. The role involves coordinating patient care, handling DME services, and collaborating with multi-disciplinary teams. Ideal candidates have LPN certification, strong organizational skills, and experience in community healthcare. This position offers a hybrid work environment, combining remote and in-person patient support.

Qualifications

• Must hold current LPN license to practice in Massachusetts.
• Minimum 2 years experience in community-based care required.
• Preferred 3+ years in outreach with complex behavioral health needs.

Responsibilities

• Evaluates the medical necessity and efficiency of healthcare services.
• Processes orders for DME and nutritional supplements.
• Conducts follow-up calls with patients to ensure satisfaction.

Skills

Time management

Problem solving

Interpersonal skills

Organizational skills

Communication

Education

High School Diploma, GED

Associate's Degree

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Electronic Medical Record systems

Job description

The iCMP Plus Licensed Practical Nurse (LPN) functions within and is an integral part of an inter-professional team. This team is responsible for the care coordination and care delivery of a panel of Medicaid ACO patients. The LPN will be responsible for evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of Mass General Brigham's Mass Health benefits plan. The LPN is responsible for the provision of Durable Medical Equipment (DME) through completion of necessary paperwork (in coordination with the assigned Advanced Practice Clinician), submission of requests to Mass Health and identified vendors and confirmation of receipt by the patient. The LPN is additionally responsible for the provision of PCA services and HHA services for the iCMP PLUS patient panel as appropriate and necessary. This role also includes providing input to members' care teams on key care management/care coordination decisions, including the adjustment of the member centered care plan and identification of the need for durable medical equipment and services. Finally, this position may require in-person visits to patients in their homes and will support patients across the iCMP PLUS Program.
*Knowledge and experience with DME/medical supplies and Medicare/MassHealth guidelines strongly preferred.
*Experience with disability issues preferred.
*Proven skills and judgment necessary for independent decision making.
*Strong organizational, time management and problem solving skills.
*Ability to function effectively within a multi-disciplinary team.
*Effective oral and written skills. Strong interpersonal and customer relations skills.
*Comfort working with DME vendors, verifying accuracy of products and quotes.
*Demonstrated proficiency with Microsoft Excel, Word and Outlook
The iCMP PLUS LPN will report to the Director of Community Complex Care and a dotted line to the iCMP Plus Clinical Manager.
Essential Duties and Responsibilities
*Conducts decision review for services requiring prior authorization in DME, leveraging technology, guidelines and resources as available.
*Processes orders for supplies, equipment and nutritional supplements based on referrals from the interdisciplinary team and submits referrals for authorization by MassHealth; leverages preferred providers and clearly notes rationale for use of non-preferred providers if/when used.
*Serves as subject matter expert in DME within -MGB's iCMP PLUS Program.
*Assures proper, accurate and timely documentation in the medical record.
*Works closely with the interdisciplinary team and escalations with the Director of Clinical Operations and Client Programs as well as Clinical Management to determine next steps for DME requests, including denials following identified Standard Operating Procedures (SOP).
*Communicates status of DME, HHA and PCA services and orders in the medical record to facilitate communication between the interdisciplinary team and LPN
*Assesses need for additional structured clinical data for completion of service request.
*Handles all requests timely and accurately, adhering to performance and operational measures.
*Follows department and organizational policies and procedures as well as adheres to all applicable regulatory, contractual and compliance requirements.
*Performs all activities with closed loop processes.
*Conducts follow-up telephone calls with patients to ensure satisfaction with equipment purchases/modification and track on spreadsheet. Bring concerns to supervisor as necessary
*Maintains appropriate written and oral communication on a timely basis, completing documentation within 48 hours and returning non-urgent calls within 48 hours.
*Identify gaps in care, barriers to care and unmet patient needs.
*Coordinate with the Care Partner along with the PCP and iCMP Plus inter-professional care team to identify areas of opportunity, as well as defined resources.
*Provide input to patients care team on key care management/care coordination decisions.
*Support efforts to decrease hospital readmissions and high emergency department use.
*Participate in weekly Interprofessional Care Team meetings.
*Ensures appropriate documentation of all activities within EPIC system
*Provides consultation and support to other members of the iCMP Plus Care Team.
*Other related duties may be assigned.
Additional Duties and Responsibilities
*Actively participates in the evaluation of own performance and progress
*Participates in on-going education and training to improve skills
*Assists management with the development, refinement and enhancement of clinical programs, initiatives, processes, policies, workflows, and projects.
*Participates in committees and workgroups that promote clinical excellence.
*This position is a hybrid work model combining home-based, community-based and office work requirements:
oThis position may require in person visits to patients in their homes and will support patient across various locations in Massachusetts.
oThis position requires travel to MGB sites and offices per required need for various team meetings.
*Valid driver's license with no restrictions. Ability to be active and mobile across Massachusetts

Education

• Minimum Education Required - High School Diploma, GED or equivalent experience
• Preferred Education- Associate's Degree

Experience

• Minimum Years' Experience Required: High School Diploma with 2 years experience in community-based care
• Must hold current LPN to practice in Massachusetts
• Preferred Years' Experience: Associates Degree with 3+ years of minimum experience working in outreach or in the community with members who have high behavioral health needs and high medical complexity.
• Preferred Training and Certification(s):
• Current CPR Certification

Knowledge, Skills, Abilities

• Excellent written and verbal communication skills.
• Working knowledge of Microsoft Office applications
• Excellent organizational skills.
• Ability to utilize an Electronic Medical Record
• Ability to use on-line training platforms
• Demonstrated understanding of Mass health benefits
• Ability to review welcome packets and obtain consent forms
• Demonstrated understanding of LTSS

Mass General Brigham Medical Group, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.