LPN Case Coordinator

REPORTS TO: CM Supervisor

LOCATION: Allegiance office or off-site

FSLA STATUS: Hourly

POSITION RESPONSIBILITIES:

This position assists with the evaluation of medical care alternatives for cases of illness, injuries or medical/surgical diagnoses that require extensive services. The role of the LPN CM Case Coordinator is to coordinate referral requests and to promote high quality care by applying clinical acumen and the appropriate application of policies and guidelines to referral requests for services outside of ACM. This role of the LPN is to facilitate quality health care by decreasing fragmentation, enhancing the patient's quality of life, while containing costs, resulting in more effective outcomes. The role will also serve as a support when screening for case management services and may be responsible for the liaison to steering to disease management programs.

The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and be respectful and courteous in the conduct of this position

ESSENTIAL JOB FUNCTIONS:
Essential job functions include the following. Other functions may be assigned as business conditions change.

• Completes clinical assessment and determines who may qualify for case management based on clinical judgment, changes in members health and triggers from assessment
• Able to screen claims triggers for case management needs
• Is the SME for referrals to specialized client vendor partners (this role is assigned on an individual basis to meet the needs of established client specific policies and procedures).
• Pre and post care planning on surgical admissions
• Facilitates discharge planning follow up calls and screens for and initiates referrals for chronic care management program
• Able to effectively initiate and return telephone messages independently, as evidence by individual compliance with Quality Assurance (QA) requirements.
• Provide accurate information to callers as evidenced by software entry/documentation.
• Compliance with protocols and QA requirements.
• Able to function as training preceptor as evidenced by completion of trainee checklist.
• Participates in team meetings, committees, or committee assignments as evidenced by:
• Completion of tasks assigned by team or committee.
• Completion of team QA evaluation in compliance with QA protocol; and
• Knowledge to present and participate in provider/subscriber and group services, workshops, and educational seminars.
• Review letters daily
• Preparation of forms, faxing, copying.
• Organization of files and reference materials.
• Ability to operate typical office equipment and working knowledge of basic office practices.
• Contributes to daily workflow with regular and punctual attendance.

NON-ESSENTIAL JOB FUNCTIONS:

• Performs related or other assigned duties as required or directed. 

PHYSICAL WORKING CONDITIONS:
Physical requirements are representative of those that must be met to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Sitting: 80%

Reaching: Minimal

Standing: 10%

Manual Dexterity: Ability to type/keyboard

Walking: 10%

Telephone: High Degree

Kneeling: As needed

Computer Screen: High Degree

Bending: As needed

Lifting: 25 pounds

JOB SPECIFICATIONS:
To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Licensure:

• Current licensure as a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN).
• At least one year experience
• Must maintain all licensure creden