Practical Nurse for Care Coordination
2 weeks ago
As a Practical Nurse specializing in Utilization Review, you will play a crucial role in patient care management. Your responsibilities will include assessing patient requirements, formulating care strategies, coordinating healthcare services, advocating for patient needs, and providing essential education and support.
Key Responsibilities
- Act as a liaison among healthcare providers, insurance companies, and community resources to enhance patient outcomes and ensure seamless care transitions.
- Maintain precise and current medical documentation, detailing patient evaluations, care actions, medications given, and other pertinent information.
- Engage in quality enhancement initiatives aimed at refining care delivery, boosting patient results, and ensuring adherence to quality benchmarks.
- Conduct medical necessity and level of care assessments for requested services utilizing clinical expertise and refer to Medical Directors as necessary.
- Offer clinical insights and serve as a resource for non-clinical team members.
- Collaborate with various personnel within provider networks and discharge planning teams to ensure comprehensive member care.
Qualifications
- Minimum of 1 year of experience in case management, particularly with the adult, blind, and disabled populations over the age of 21.
- Proficient in computer applications, particularly MS Office.
- Valid LVN, LPN, or LCSW certification required.
- Bilingual candidates are preferred.
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