LPN, Care Manager

Pediatric Associates Family of Companies; Plantation (FL); Remote; USD 50,000 - 70,000; Full time

Job summary

A leading health care provider seeks a licensed practical nurse (LPN) to join as a Care Manager. The role primarily involves coordinating care for pediatric patients, ensuring effective communication among health teams, and contributing to quality improvement initiatives. Ideal candidates should possess strong patient management skills, relevant experience, and LPN licensure.

Qualifications

• Minimum 3 years healthcare experience required.
• Licensure as an LPN/LVN required.
• Care management experience preferred.

Responsibilities

• Conducts assessments and collaborates with healthcare teams.
• Communicates treatment changes to involved parties.
• Completes documentation in electronic health records.

Skills

Patient management skills

Strong customer service skills

Excellent decision-making skills

Excellent interpersonal skills

Education

Associate degree or technical schooling in related area

Job description

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Primary Function

The Care Manager, LPN assists in the care coordination for identified medically fragile and complex pediatric patient population. Functions as a liaison between the patient and the care team. Interacts with Primary Care Physician (PCP), front office, outside specialists, health plans, and patients/caregivers. Provides guidance and direction to Chronic Care Coordinators and may provide education to patients.

Essential Duties And Responsibilities

This list may not include all the duties that may be assigned.

• Conducts outbound calls to complete assessments of targeted medically complex pediatric patients. Collaborates with family and patient health care team to identify patient needs.
• Reviews current plans of care and makes recommendations per current state guidelines for medical necessity. Collaborates with the Medical Director to ensure appropriate service delivery including review of findings, criteria not met, determination of appropriate level of care, delay in services, alternative solutions, etc.
• Communicates treatment changes to the PCP, family, healthcare team, and others involved in patient care.
• Assists with coordinating and may participate in multidisciplinary rounds, peer to peer reviews, and individual case reviews for established patients.
• Participates in quality review processes to ensure active reviews are completed.
• Completes documentation in the care management platform and electronic health record.
• Responds to incoming and outgoing correspondence and requirements of plans of care and recertification.
• Reviews incoming referrals, plans of care, and consult notes. May escalate to the medical director for follow up.
• Functions as a resource on state requirements for home health guidelines.
• Participates in ongoing development, implementation, and evaluation of program and process effectiveness. Formulates recommendations for process modifications. Identifies opportunities and recommends methods to improve service, processes, and financial performance.
• Participates in internal initiatives. Participates in gathering information and data for CMS reporting.
• Functions as expert resource for staff. Provides guidance and direction to Chronic Care Coordinators and may provide education to patients.
• Provides courteous and prompt service to all internal and external customers.
  
  

Remote Opportunity

Schedule: Monday - Friday 8am - 5pm EST

Primary Function

The Care Manager, LPN assists in the care coordination for identified medically fragile and complex pediatric patient population. Functions as a liaison between the patient and the care team. Interacts with Primary Care Physician (PCP), front office, outside specialists, health plans, and patients/caregivers. Provides guidance and direction to Chronic Care Coordinators and may provide education to patients.

Essential Duties And Responsibilities

This list may not include all the duties that may be assigned.

• Conducts outbound calls to complete assessments of targeted medically complex pediatric patients. Collaborates with family and patient health care team to identify patient needs.
• Reviews current plans of care and makes recommendations per current state guidelines for medical necessity. Collaborates with the Medical Director to ensure appropriate service delivery including review of findings, criteria not met, determination of appropriate level of care, delay in services, alternative solutions, etc.
• Communicates treatment changes to the PCP, family, healthcare team, and others involved in patient care.
• Assists with coordinating and may participate in multidisciplinary rounds, peer to peer reviews, and individual case reviews for established patients.
• Participates in quality review processes to ensure active reviews are completed.
• Completes documentation in the care management platform and electronic health record.
• Responds to incoming and outgoing correspondence and requirements of plans of care and recertification.
• Reviews incoming referrals, plans of care, and consult notes. May escalate to the medical director for follow up.
• Functions as a resource on state requirements for home health guidelines.
• Participates in ongoing development, implementation, and evaluation of program and process effectiveness. Formulates recommendations for process modifications. Identifies opportunities and recommends methods to improve service, processes, and financial performance.
• Participates in internal initiatives. Participates in gathering information and data for CMS reporting.
• Functions as expert resource for staff. Provides guidance and direction to Chronic Care Coordinators and may provide education to patients.
• Provides courteous and prompt service to all internal and external customers.
  
  

Qualifications

EDUCATION: Minimum associate degree or two years’ technical schooling in related area required. Combination of education and experience in care management, practice administration and/or managed care will be considered.

EXPERIENCE: A minimum of 3 years previous healthcare experience required functioning as an LPN/LVN,

A minimum of 5 years preferred. Care management experience in managed care industry, physician group practice or health care required.

LICENSURE / CERTIFICATION: Licensure as an LPN/LVN or higher required.

Knowledge, Skills, And Abilities

• Patient management skills
• Strong customer service skills including de-escalation expertise.
• Knowledge of medical billing and health records maintenance.
• Excellent interpersonal and communication skills.
• Excellent decision-making and problem-solving skills.
• Detail oriented and analytical skills.
• Knowledge of laws governing the protection of patients’ private health information.
  
  

TYPICAL WORKING CONDITIONS

• Non-patient facing
• Full time remote requires quiet workspace without distractions or interruptions while interacting with patients and caregivers.
• Must be U.S. based.
• Indoor work, operating computer.
• Sitting
  
  

Other Physical Requirements

• Vision
• Sense of sound
• Sense of touch
  
  

Performance Requirements

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

PI272166372

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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