LVN Care Coordinator - Inpatient Case Management - SRS Copley - Days - PRN

Hours:

Shift Start Time:

8 AM

Shift End Time:

4:30 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

1 weekend shift sat/sun per month

Weekend Requirements:

As Needed

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$36.400 - $46.970 - $57.540

 

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. 

 

This position would require you to float as needed to the following Sharp hospitals: Memorial, Grossmont, and Chula Vista.

What You Will Do
To provide discharge planning and coordination of care for members hospitalized in the acute care setting in collaboration with the Hospitalist team, SRS primary care physician, and ancillary staff to ensure cost effective quality service throughout the continuum of care.

Required Qualifications

• Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program.
• California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians -REQUIRED

Preferred Qualifications

• 1 Year experience in the acute patient care, SNF, home health, or hospice settings.
• Experience as a case manager or discharge planner interacting with managed care payers.
• Experience with InterQual or Milliman Guidelines.

Essential Functions

• Census and rounds
  Reviews every patient under assigned workload initially and reviews based on review of care plan.
  Makes rounds and sees every patient identified per departmental guidelines during hospital stay beginning with the admission review of the case manager and reviews with the Case Manager Lead, as needed.
  Keeps SRS Leadership informed of any adverse development, delay in discharge or services, readmissions to acute or visit to the Emergency Department.
  Informs Director, QI/UM of any quality issues.
  Attends hospitalists rounds, as required, to discuss high risk patients requiring case management follow up.
  Attends clinical in-services or required operational/clinical training sessions.
• Act as a resource
  Demonstrates knowledge of Health Plan contracts and Health Plan benefits Coordinates services and supplies through SRS (or health plan, as applicable) contracted vendors.
  Supports compliance with all applicable regulatory and health plan guidelines for issuance with notices of non-coverage, etc.
  Identifies services that are not medically necessary and/or not covered benefits and accurately follows Health Plan and/or Medicare Guidelines when issuing denials.
  Ensures that all denials for medical necessity are issued under the direction of the Medical Director or designee.
  Assists with transfers, when necessary.
• Demonstrates knowledge of department policies and procedures
  Demonstrates knowledge of Health Plan contracts and Health Plan benefits.
  Coordinates services and supplies through SRS (or health plan, as applicable) contracted vendors.
  Provides authorization as needed for DME or other services for skilled nursing facility placement or home care.
  Ensures compliance with all applicable regulatory and health plan guidelines for issuance of notice letters.
  Assures that letters are issued accurately and served timely to members or responsible party.
  Ensures that all denials for medical necessity are issued under the direction of the appropriate Medical Group Physician Representative.
  Collaborates with SCMG Medical Group Appeals when necessary.
• Chart Review
  Documents Initial discharges follow up three days (or sooner depending on the case) after the Initial Screen by the Case Manager and continues to follow up every three days for the duration of hospitalization.
  Discusses with hospitalist the discharge plan and barriers in rounds, in person or by phone.
  Tracks and documents key performance measures related to inpatient management per requirements.
  Reviews patient medical record including, but not limited, to progress notes, orders, vital signs, laboratory results.
  Communicates with the PCP and also discuss with the PCP's nurse if the physician is unable to come to the phone for patient issues, when needed.
  Performs data entry related to patient management activit