LPN Review Nurse

6 days ago

Clearwater, United States Evara Health Full time
Do you want to make a difference in the community?

Are you looking to further your career in healthcare?

Do you want to be part of a growing organization?

Evara Health has been serving the community for 40 years. We are a not-for-profit health care organization with 14+ locations throughout Pinellas County, FL

GENERAL DESCRIPTION:

Under the direction of the Value Based Services (VBS) Manager, the Value Based Services (VBS) Nurse assesses, plans and coordinates all aspects of medical and supporting services across the continuum of care for assigned members to promote quality and cost-effective care, through the ongoing support of individual patient needs. The VBS Nurse provide the medical care team with patient utilization information, evaluate and addresses potential care gaps

ESSENTIAL DUTIES & RESPONSIBILITIES:
  • Assesses the level of need of individuals/families assigned for VBS management services including individuals with medically complex needs, chronic illnesses and intellectually challenged individuals
  • Conducts detailed analysis for the assigned patients to identify possible gaps in care and determine necessity of medical or non-medical interventions based on nursing knowledge, Evara Health policies and procedures, and third-party payors guidelines
  • Provides ongoing outreach to a caseload of identified Evara Health patients. Communicates with patients to encourage healthy behaviors and ensure patients are well informed and empowered to make proactive decisions about their own care and provide necessary education
  • Keeps accurate records of caseloads and ensures that any required measures are completed and reported in a timely manner
  • Completes all documentation within 24hrs as per agency standard including case records, case notes, and outcome measures
  • Meets regularly with program manager to review cases and job performance
  • Collaborates with Evara Health providers and clinical teams.
  • Schedules and maintains appointments with providers and clinics to provide education related to reviews
  • Performs plan-specific activities as required (Health Risk Assessments, Annual Wellness Outreach, etc.)
  • Maintains confidentiality within the workplace with all written and verbal communications pertaining to, staff, and community operations.
  • Leverages best practices using advanced analytics models, and data driven strategies to improve and optimize patient outcomes. Knowledgeable of HEDlS and the use of HEDIS gap reports/Meaningful Use reports/data reports in relationship to clinical visits/billing and some coding knowledge

MINIMUM QUALIFICATIONS:
  • Successful track record in health care setting
  • Strong oral and written communication skills
  • Ability to effectively navigate and enter data into an EHR; Strong Microsoft Office Suite skills, specifically Word, Excel, and ability to utilize data analytics programs
  • Excellent interpersonal skills and ability to develop and maintain effective working relationships with patients and coworkers
  • Highly organized, with excellent attention to detail and problem-solving skills
  • Professional demeanor
  • A self-motivated, independent, highly driven and results focused individual
  • Coding knowledge preferred

EDUCATION AND EXPERIENCE:
  • Graduate of an accredited LPN or RN program
  • Minimum two (2) years of experience as an LPN or RN in healthcare
  • Minimum one (1) year of experience as a Utilization Review Nurse or Case Manager

LICENSES, CERTIFICATION OR REGISTRATION:
  • Active and unencumbered LPN or RN License in the State of Florida
  • Current BLS Certification

CULTURE

Evara Health strives to not only be the healthcare provider of choice, but also the employer of choice, one that offers you the opportunity to excel in your career and be a difference maker in the lives of the patients we serve.

BENEFITS
  • Up to 18 days of PTO in your first year
  • Pre-Taxed flexible insurance package
  • 403B with company contributions
  • Tuition reimbursement
  • Paid Training
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