Clinical Case Coordinator LVN

2 weeks ago

Bakersfield, California, United States PACS Inc Full time
PACS Inc is seeking a dedicated and skilled Clinical Case Coordinator LVN to join our dynamic management team. This role is essential in guiding a proficient group of CNAs and providing comprehensive training for all staff members. The ideal candidate will exhibit a calm demeanor in high-pressure situations, demonstrate enthusiasm, and be a collaborative team player with a strong work ethic.

Key Responsibilities:
  • Maintain regular communication with the interdisciplinary team (IDT) regarding members' care plans, physical therapy (PT), occupational therapy (OT), and other treatment protocols.
  • Participate actively in morning stand-up meetings and IDT discussions to enhance team communication.
  • Engage in collaborative meetings with the IDT and insurance representatives to address ongoing skilled care needs of members.
  • Prioritize and organize daily tasks by reviewing managed care lists and facility census activities, coordinating with case management colleagues and insurers.
  • Ensure timely completion of documentation to meet compliance standards set by insurers.
  • Monitor facility census activities and liaise with facility teams to effectively track and manage members on skilled caseloads.
  • Support facilities by overseeing the continued stay authorization process and ensuring all skilled authorizations are secured for dates of service.
  • Perform clerical duties, including e-faxing, phone communications, uploading authorization determinations, and compiling files to meet case management objectives.
  • Gather data from electronic medical records and IDTs to conduct concurrent reviews.
  • Exhibit the ability to work independently while exercising sound judgment in interactions with providers, payers, and facilities.
  • Communicate effectively to foster cooperation among providers, payers, facility IDT, and case management team members.
  • Demonstrate excellent time management skills to create organized workflows in a fast-paced environment with shifting priorities.
  • Possess intermediate computer skills.
  • Build positive relationships with providers, facility staff, and professional colleagues.
  • Communicate with facility personnel, providers, financial services, and third-party payers regarding care plans and authorization statuses.
  • Conduct utilization review activities to ensure residents receive appropriate, timely, and cost-effective care.
  • Monitor residents' conditions and communicate changes to the IDT and insurance partners promptly.
Qualifications:
A Bachelor's Degree in Nursing or Business Administration is preferred. Candidates with a valid LVN or LPN license, or licensed therapists (physical, occupational, or speech) are acceptable. A minimum of two years of experience in nursing clinical settings, managed care insurance, or case management is preferred. Familiarity with Medicare, Managed Care, and Medicaid programs is essential. Knowledge of PCC and Net Health systems is advantageous.

Licenses and Certifications:
A valid LVN/LPN or RN license in the relevant state is required. Candidates with valid PT, OT, or ST licenses will also be considered. Certification as a Certified Case Manager (CCM) is a plus. Continuous education and licensing must be maintained, and candidates must remain in good standing with the Department of Public Health.

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