LPN - Care Coordinator - Fort Myers, FL - Full-time / Part-time

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
 
Primary Responsibilities:


Coordinates follow - up care appointments and/or assists in directing care to physician clinic nurse or ITC clinic and / or medical services for post - hospitalized patients and assures timely and complete communication to ITC clinics when applicable.
Assesses patients clinical information and effectiveness of current medical services through phone interview, following either the WellMed or Milliman specified template for the type of call being made
Investigates and solves problems relating to patient responses indicating continued medical problems, plan of care failures, knowledge deficits and other responses of concern
Provides health services counseling regarding identified patient knowledge deficits, such as dietary information, medication orders explanation, and rationale for immediate follow up with primary care physician / ITC, etc.
Provides members with information on how to access services within WellMed including newly identified transportation needs
Identifies need for non - covered services and provides options for the patient with the assistance of WellMed case manager(s) and / or social worker(s)
Identifies urgent issues and forwards to the case manager, case manager supervisor, case management manager, or PCP as indicated
Makes follow - up calls to member as necessary to resolve items identified on initial call
Notifies case manager if information is obtained indicating the member is using a non-participating or non - authorized provider to allow case manager to investigate and pursue either an LOA for services or to redirect services in plan, or that patient has been institutionalized
Develops and maintains a network of providers, contacts, staff and other customers who may be able to assist in establishing care with new patient or arranging acute care appointments
Provides PCP with outpatient care assessment information and documents follow - up and interventions in the Case Management Documentation System (CMDS).
Quality:

Identifies, documents and reports quality of care issues and provider concerns reported by the member
Works collaboratively with case managers to share information regarding potential catastrophic, high cost, or individual patients, and any inpatient admissions upon notification
Takes ownership of the total work process and provides constructive information to minimize problems, increase customer satisfaction, identify ways to improve position efficiency, and makes process suggestions to the appropriate manager
Strives to personally expand working knowledge of all aspects of WellMed departments and attends and contributes to UM meetings
Customer Service:

Performs all duties to customers in a prompt, pleasant, professional and responsible manner regardless of the stressful nature of the situation. Provides members his / her name, title and phone number
Returns all voicemail within one business day, and all follow up calls within one business day or as agreed upon with the member
Works collaboratively with the member and healthcare professionals to meet needs of patients' overall healthcare requirements
Interacts with all WellMed departments and case management to provide customer services and assistance in the referral process and individual needs for patients.
Compliance:

Provides members information regarding benefits and coverage. Is aware of general authorization guidelines, and seeks assistance in responding to questions regarding authorization from members
Demonstrates knowledge of health plan benefits, policies and procedures, and quality of care criteria, including review of all new and revised information on these subjects. Maintains HIPAA compliance in all communication, including but not limited to telephonic conversations with family members, mailed information and voicemails

Required Qualifications:


High School diploma or GED
Current LPN license in state of Florida 
Previous experience in physician’s office as LPN in back office or hospital floor nurse of medical / surgical bed
3+ years of experience that is directly related to the duties and responsibilities specified
Possess planning, organizing, conflict resolution, negotiating, and interpersonal skills
Knowledge of legal ethical issues related to patients’ rights, rehabilitation terminology, discharge guidelines, community support services and funding
Ability to observe, assess and report success of discharge planning
Strong interpersonal, communication and teamwork skills
Proficient with Microsoft Office programs including Word, Excel, and ability to learn proprietary programs
Independent problem identification / resolution and decision making skills

This position requires AHCA level II background checks (fingerprinting) by the state of FL for all clinicians that have face to face contact with members or employees who have access to confidential patient data and will require renewal every five years
Preferred Qualifications:


Associate's degree

Understanding of management practices or health plan administration of referral process, triage or medical management
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
 
 
Job Keywords: medical management, case management, LPN, care coordination, care assessment, Fort Myers, FL, Florida