LCC CLINICIAN

Liberty Resources; Philadelphia (Philadelphia County); On-site; USD 58,000 - 76,000; Part time

Job summary

Liberty Community Connections in Philadelphia, PA is seeking an LCC Clinician to provide oversight of Consumer Critical Incidents in collaboration with MCO Incident management and Service Coordinator teams.

The role requires PA RN license or Licensed Clinical Social Worker, 2+ years in managed care (or 5+ years nursing), and 3+ years in case management. 80% office work with 20% travel; reliable transportation is needed to perform field duties. This position reports to the Quality Manager.

Qualifications

• Current, unrestricted PA RN license or Licensed Clinical Social Worker.
• 2+ years of experience in managed care OR 5+ years nursing experience.
• At least 3 years case management, concurrent review or utilization management experience.

Responsibilities

• Ensures timely review of Consumer Critical Incidents to determine appropriate CMS and regulatory actions.
• Reviews home care and inpatient/outpatient treatment plans for medical necessity and efficiency.
• Collaborates with MCO Incident management and Service Coordinator teams to determine medical and social appropriateness of inpatient and outpatient services.
• Assists with Complex cases and PCSP processes, and medication review.
• Follows consumer until incident concludes.
• Identifies quality issues and refers fraud/abuse to Compliance.
• Other duties as assigned.

Skills

Interpersonal skills

Communication

Organizational skills

Confidentiality

Problem solving

Conflict resolution

Education

Registered Nurse license (PA)

Licensed Clinical Social Worker

Job description

Job Details

Job Location: Philadelphia, PA 19107

Salary Range: $42.00 - $55.00 Hourly

Position Title: LCC Clinician

Direct Reports: N/A

Reports To: Quality Manager

Schedule: Part Time

Division/Department:

Status and EEO Classification:

Last Date Revised: n/a

Summary: This position will report to the Quality Manager and will be responsible for working in collaboration with the MCO Incident management and Service Coordinator teams, both internal and external to provide oversight on participants Critical Incidents.

Necessary Equipment and Access

Personal computer (Microsoft Office Suite), telephone, photocopier, fax machine, scanner, desk, chair and file cabinet

Work Environment and Physical Demands

Work is performed in one of the LCC Regional offices (80% in the office; 20% travel). Employee must have reliable transportation in order to complete field assistance, when needed. Employee may be asked to attend meetings outside of the primary worksite. This position has physical requirements which may include but are not limited to:

• The operation of basic office equipment such as a copier, fax machine, computer, keyboard, calculator, telephone;
• The ability to frequently sit, stand, bend, lift, carry, push and pull (20 lbs.) with or without reasonable accommodations to perform the essential responsibilities of the position;
• In some cases, local or national travel maybe required.

Essential Responsibilities

• Ensures timely review of Consumer Critical Incidents to determine if the appropriate measures are taken in the areas of reporting in accordance with MCO and CMS coverage guideline and State Regulatory requirements.
• Reviews proposed home care, and inpatient / outpatient treatment plans for medical necessity and efficiency in accordance with CMS coverage guidelines.
• Will work in collaboration with the MCO Incident management and Service Coordinator teams, both internal and external to determine medical and social appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
• Assist Service Coordinator teams with Complex cases, PCSP process where necessary and medication review.
• Will follow the consumer until the Incident has reached conclusion.
• Identify and refer all potential quality issues to the Quality Management Department, and suspected fraud and abuse cases to Compliance Department.
• Other duties as assigned.

Qualifications Minimum Qualifications

• Current, unrestricted Pennsylvania RN license or Licensed Clinical Social Worker
• 2+ years of experience in managed care OR 5+ years nursing experience
• At least 3 years case management, concurrent review or utilization management experience
• Ability to interact productively with individuals and with multidisciplinary teams with minimal guidance
• Possess planning, organizing, conflict resolution, negotiating, and essential interpersonal skills

Skill Requirements

• Interpersonal skills
• Effective and positive communication skills
• Strong organizational skills
• Confidentiality
• Problem solving and analytical skills
• Conflict resolution skills
• Proficient in PC Software computer skills

Liberty Community Connections is an affirmative action, equal opportunity employer and makes reasonable accommodations for Persons with Disabilities.