LVN Telephonic Service Coordinator - Telecommute in Harris County, TX - Full-time / Part-time

The primary purpose of the LVN Telephonic Service Coordinator is to deliver Telephonic Support Service Coordination, Community Resource integration, and Psychosocial support. This results in consistent, collaborative, and coordinated care based on Member needs and Risk profile. Identifying Member needs begins with early identification of Health Risk factors, as identified by the member. 

Employees in this position require various Nurse licensure and certification, based on role and grade level. Licensure includes RN and LPN/LVN, depending on grade level, with current, unrestricted licensure in The State of Texas. These roles identify, coordinate, or provide appropriate levels of care under the direct supervision of an RN or MD. This function is responsible for Clinical Operations and Medical Management activities across the continuum of Care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes Case Management, Coordination of Care, and Medical Management Consulting. This role may also be responsible for providing Health education, Coaching and Treatment Decision support for Members. Includes Health Coach, Health Educator, and Health Advocate roles that require an RN.

Primary Responsibilities:

• Basic, structured, and standard approach to work.
• Requires current and unrestricted LVN Licensure in The State of Texas.
• Engage Member and Stratify:
• Respond with appropriate coordination of Care and Services protocol by level of Care assignment.
• Complete telephonic Risk Stratification Assessment, if necessary.
• Contact member to explain Care Management process and complete Welcome Call Assessments on New members.
• Share input into the Plan of Care with appropriate members of the Care team so that Care Team members are working toward uniform Member goals.
• Utilize Motivational Interviewing techniques to obtain Member information, including: family, caregivers, Providers' reporting, etc.
• Deliver and Coordinate Services:
• Identify Formal and Informal resources to meet the Member needs as stated in the Plan of Care.
• Enter Service notifications/authorizations according to guidelines.
• Communicate with the Member, Primary Care Physician, and Community partners concerning Service and Behavioral Health needs, as well as alternatives to providing services to meet those needs.
• Serve as Member advocate and facilitator to resolve issues that may be barriers to Care.
• Through developing a relationship with the member/family, the Care Manager educates the member/family about their Behavioral Health conditions, Socialization options, Treatment options, Community resources, and Insurance benefits so that informed decisions can be made and Member self-management is promoted.
• Complete delegated activities from the Health Services Manager, as appropriate, surrounding the provision of information related to Health conditions and Treatment options as a part of the Plan of Care.
• Ensure appropriate utilization and consistent application of Benefits, and apply Benefits Coordination knowledge.
• Maintain time-sensitive documentation, including Case Management/Service Coordination interventions and outcomes to assure compliance with regulatory agencies and program goals.
• Perform other duties, as assigned. 

• High School Diploma/GED.
• Licensed Vocational Nurse (LVN) licensure within the State of Texas.
• 3+ years of Clinical experience as a LVN.
• Working knowledge of Medicare/Medicaid Regulations.
• Working knowledge of Medical Terminology.
• Previous experience working with a computer and Microsoft Office products.

Preferred Qualifications:

• Bilingual fluency with English and Spanish.
• Long Term Care experience.
• Managed Care experience in a Care Coordination role.
• Experience in a Health-related, Telephonic Customer Service setting.
• Experienced in meeting the needs of vulnerable populations who have chronic or complex conditions.
• Case Management experience in a Clinical setting (i.e., Hospital, Long Term Care, etc.)