LICENSED VOCATIONAL NURSE-LCM
hace 22 días
Pomona
Job Description The Lead Care Manager (LVN) works in collaboration and continuous partnership with chronically ill or “high-risk” members and their family/caregiver(s), clinic/hospital/specialty providers and staff, and community resources in a team approach to: • Coordinate with those individuals and/or entities to ensure a seamless experience for the member and non-duplication of services, • Engage eligible members, • Oversee provision of ECM services and implementation of the care plan., • Offer services where the member lives, seeks care, or finds most easily accessible and within the Plan guidelines, • Connect member to other social services and supports the member may need, including transportation, • Advocate on behalf of members with health care professionals, • Use motivational interviewing, trauma-informed care, and harm-reduction approaches, • Coordinate with hospital staff on discharge plans, • Accompany member to office visits, as needed and according to the Plan guidelines, • Monitor treatment adherence (including medication), • Provide health promotion and self-management training, • Promote timely access to appropriate care, • Increase utilization of preventative care, • Reduce emergency room utilization and hospital readmissions, • Increase comprehension through culturally and linguistically appropriate education, • Create and promote adherence to a care plan, developed in coordination with the member, primary care provider, and family/caregiver(s), • Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals, • Increase members’ ability for self-management and shared decision-making, • Connecting members to relevant community resources to enhance member health and well-being, increase member satisfaction, and reduce health care costs, • Connect and follow up with members, family/caregiver(s), providers, and community resources via face-to-face, secure email, phone calls, text messages, and other communications, • Serve as the contact point, advocate, and informational resource for members, care team, family/caregiver(s), payers, and community resources, • Work with members to plan and monitor care, • Assess member’s unmet health and social needs, • Develop a care plan with the member, family/caregiver(s), and providers (emergency plan, health management plan, medical summary, and ongoing action plan, as appropriate), • Monitor adherence to care plans, evaluate effectiveness, monitor member progress on time, and facilitate changes as needed, • Create ongoing processes for members and family/caregiver(s) to determine and request the level of care coordination support they desire at any given time, • Facilitate member access to appropriate medical and specialty providers, • Educate members and family/caregiver(s) about relevant community resources, • Facilitate and attend meetings between members, family/caregiver(s), care team, payers, and community resources, as needed, • Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals, • Assist with the identification of “high-risk” members (the chronically ill and those with special health care needs), and add these to the member registry (or flag in EHR), • Attend all Lead Care Manager training courses/webinars and meetings, • Provide feedback for the improvement of the ECM Program, • Offer services where the Member lives, seeks care, or finds most easily accessible and within Medi-Cal Managed Care health plans (MCP) guidelines, • Engage eligible Members, • Arrange transportation, • Call Member to facilitate Member visit with the ECM Lead Care Manager QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below represent the required knowledge, skill, and/or ability. Reasonable accommodations may enable individuals with disabilities to perform essential functions. • Although this role is remote, there will be times when you will be required to report to our satellite office (or a specified, remote location) to work, to attend meetings, or other training, • Required to have and maintain your own personal vehicle for this role You will receive a monthly mileage reimbursement per applicable state/federal laws • You must have a valid driver’s license, proof of insurance, and a good driving record, • You will visit hospitals and visit patients at their homes, as needed, • Must present proof of Negative TB Test & CPR Certification before hire date, • Must complete a Live Scan Fingerprint/Background check EDUCATION AND/OR EXPERIENCE: • An associate’s degree, or bachelor's degree in health science or any related health care degree is preferred, • Social Worker, LVN, or experience in case management is a PLUS! SKILL AND KNOWLEDGE REQUIREMENTS: • Excellent analytical, problem-solving, and prioritization skills, • Excellent verbal and written communication skills, • High-level of interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams that may include employees, customers, and physicians, • Effective computer skills, particularly Microsoft Office, Excel, PowerPoint, Word, etc., • Work independently to complete assigned tasks, • Team building, • Project Management, • Change Management, • Quality and Process improvement tools, • Project Execution, • MUST consistently achieve a minimum daily expectation of 30 schedules/day BENEFITS: • Medical/Dental/Vision - available after successful completion of the 90-day probationary period, • Free $100K Life Insurance, • 401k eligibility after 1,000 hours of service, • Starting hourly range for this role is $30-$32 per hour