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Job Description - Case Manager / LVN Job Description: The basic concept of case management involves the timely coordination of quality healthcare services to meet an individual’s specific healthcare needs in a cost effective manner to promote positive outcomes. This can occur in an episodic or a continuous case management setting. Case management is a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes. The Case Manager / LVN is responsible for establishing, coordinating and maintaining the care of the patient under the direction of the physician team. This includes all communication with physicians, mid-level practitioners and all service providers in the field. This position is also responsible for coordination of referrals for lab, x-rays and other ancillary services. Requirements / Qualifications: - Current and unencumbered state license to practice as a LVN
- Company requirement to complete 2 CEU/month for Acute Care settings as well as 1 CEU / quarter as designated by program director
- Competent organizational skills
- Ability to handle stressful situations/deadlines
- Excellent oral/written communication and interpersonal skills
- Must demonstrate the ability to communicate effectively with all members of the collaborative healthcare team
- Forecast needs; set priorities; manage case load
- Computer proficiency
- Ability to follow instructions and ability to take constructive criticism
- Maintain an active Basic Life Support certification (CPR) and provide CPR when required.
- Performing accurate, legal, and ethical documentation
Supervisor: The Case Manager / LVN will report directly to the Director of Case Management as well as the VP of Case Management. Job Duties: 1. Triage phone calls from patients, patient family members or home health nurses and give recommendations according to problem as well as notify provider of problem and relay their orders to patient or home health nurses and make record of communication into patient chart. 2. Receive verbal orders from providers and create PDF accordingly. 3. Attend weekly case conferences and take any necessary notes. 4. Contact patient with results of any diagnostic procedures ordered by physician team. 5. Coordinate any needed visits for patients with scheduler as needed. 6. Communicate with physician team for narcotic approval or denial for prescription refills. 7. Receive and process any POD orders and correctly processing orders in patients’ charts. 8. Reviewing all DME, CMN and title 19 for medical necessity and forward to medical records for processing. 9. Complete prior authorizations on medications as deemed necessary by insurance carrier. 10. Coordinate care when necessary with home health to ensure proper patient care and best outcomes. 11. Take lunch on-call as assigned. Triage calls as well as enter a communication into Janus and informing patient providers and POD nurse for the patient. 12. Assist Clinical MA, Field MA, or provider with any questions. 13. Follow all HIPAA guidelines. 14. Attend all mandatory meetings. 15. Utilize accepted “nursing triage protocols”. 16. Maintain patients Health Maintenance records 17. Review and maintain the 485 and any recertification for services as noted with medical necessity. 18. Open communication with CPO Case Coordinators for tracking of CPO. 19. Medication reconciliation monthly Eric Butler Director of Professional Recruitment &Development American Physician Housecalls 3100 McKinnon St. (4th floor) Dallas, Texas 75201 (214) 754-8700 Ext: 222 (214) 271-4659 Fax (866) 377-7595 Toll Free eric@aphousecalls.com www.aphousecalls.com
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