LPN / Licensed Practical Nurse - Case Management

All-Ways-Caring-Homecare; Greeneville (TN); On-site; USD 30,000 - 33,000; Full time

Job summary

All Ways Caring HomeCare in Tennessee is seeking a referral and case-management professional to receive and respond to referrals, assess client needs with the clinical team, and coordinate pre-admission workups and authorization for payment. You will supervise field staff during pre-screening and liaise with payers on coverage and reimbursement options.

The role requires driving, strong communication, and HIPAA/compliance adherence, with focus on maintaining referral source relationships and

Qualifications

• Bachelor's degree in a human services field or nursing field.
• Valid driver's license.
• Must have two years of experience with case management or related discipline
• Must be able to communicate both verbally and in writing.

Responsibilities

• Receives and responds to incoming calls from referral sources and identifies clients' needs with the Director of Clinical Management to determine capability to meet them.
• Completes pre-screening assessments, reports, and case proposals, and coordinates pre-admission paperwork and payment authorization.
• Oversees field staff assigned to assist with pre-screening and coordinates with clinical teams for client care.
• Presents services to third party payers, discusses reimbursement options, and negotiates reimbursement levels.

Education

Bachelor's degree in a human services field or nursing field

Job description

Our Company

All Ways Caring HomeCare

External Job Description

• Receives/responds to incoming calls from referral sources/potential clients and exchanges information to identify the clients' needs and consults with Director of Clinical Management to determine the Company's ability to meet them.
• Completes all viable referrals by setting up and carrying out pre-screening assessments, completion of pre-screening reports, and preparation of case proposals and other related pre-admission paperwork (i.e., obtains authorization for payment, coordinates availability of an appropriate treatment team).
• Oversees, directs and supervises field staff assigned in assisting with pre-screening process.
• Accesses national/state/company account information, including the account names and terms of contracts or other past payer agreements, as appropriate.
• Consults with third party representatives regarding client benefit coverage, client financial responsibility, company service authorization and specific reimbursement procedures. Presents company’s services, interprets potential reimbursement options and negotiates reimbursement levels with third party payer.
• Contacts referral sources to advise them of case acceptance and provides information on the clinical team responsible for client's case.
• Develops/maintains a working knowledge of all services/resources provided by the Company and services available within the community. Assists in identifying alternative community service sources when company solutions are not appropriate or available.
• Maintains relationships with standard referral sources and payer case managers. Contacts identified referral sources and seeks referrals as appropriate. Records outcome of calls and keeps the SAR informed.
• Monitors/tracks referral sources' satisfaction levels, tracks/reports on conversion ratios and provides summary reports to management at requested intervals.
• Implements/maintains, with the up line management, operational processes to ensure compliance with Company policies, requirements and regulatory mandates.
• Adheres to and participates in Company’s mandatory HIPAA privacy program/practices and Business Ethics and Compliance programs.
• Participates in quarterly growth planning meetings/activities including discussions around staffing and recruitment needs.
• Participates in special projects and performs other duties as assigned.

Qualifications

• Bachelor's degree in a human services field or nursing field.
• Valid driver's license.
• Must have two years of experience with case management or related discipline
• Must be able to communicate both verbally and in writing.

About our Line of Business

All Ways Caring HomeCaredelivers quality, compassionate, and individualized care and support that helps people in need of assistance stay at home – all while maximizing their dignity, privacy, and independence. Whether recovering from illness, injury, or surgery, living with a chronic disability, or dealing with the natural process of aging, services are tailored to meet the individual needs of people of all ages, physical conditions, and cognitive abilities. All Ways Caring HomeCare services include personal care and homemaking programs, professional nursing, older adult care management, Alzheimer’s/dementia care, respite care, and other programs. For more information, please visit www.allwayscaring.com. Follow us on Facebook and LinkedIn.

Salary Range

USD $22.00 - $24.00 / Hour