Care Coordinator/ Licensed Practical Nurse (LPN)for LTSS Waiver/ Home Health in Culpeper, Fauquier, Madison, Orange, Rappahannock, VA

Sentara Hospitals • Madison, VA

3d • Hybrid

About The Position

Sentara Health Plans is hiring a Care Coordinator/ Licensed Practical Nurse (LPN) for LTSS Waiver/ Home Health in Culpeper, Warrenton, Fauquier, Catlett, Madison, Orange, Brightwood, Bealeton, Washington, Rappahannock County, Gordonsville, VA. This is a full-time, permanent position with standard working hours of 8am to 5pm EST, Monday through Friday.

Requirements

• MCO/HMO experience REQUIRED
• 3 years of clinical experience within the last 5 years
• Familiar with HEDIS measures, EPSDT, and childhood immunizations charts and periodicity schedule.

Nice To Haves

• Associate's degree in Nursing preferred.
• Bachelor's degree in Health & Human Services-related field or related experience in lieu of education accepted.
• Licensed Practical Nurse (LPN) or Bachelor's prepared health professional strongly preferred.
• 3 years of Medicaid/Medicare experience preferred
• Utilization Management experience and Chart review/audit experience preferred

Responsibilities

• Responsible for facilitation, implementation and coordination of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Member Outreach Program and overall compliance with immunization and EPSDT examinations.
• Serves as health plan resource for EPSDT/Well Child Program and all childhood exams, screenings, and vaccinations recommended by DMAS and per HEDIS measures.
• Responsible for data entry and monitoring of reports to increase utilization of EPSDT services.
• Maintains tracking system to identify new enrollees and children's non-compliance with EPSDT periodicity and immunization schedules.
• Ensures access to periodic preventive health care for members under the age of 21 years by promoting and coordinating child wellness in alignment with DMAS, health plan, and other professional organization initiatives.
• Conducts notifications of periodic screening requirements; develops educational materials and provides training to members/providers.
• Triages members with special healthcare needs (CSHN) using appropriate screening tools and assessments.
• Provides complex case management to members with complex needs.
• Performs related field work and community engagement travel as needed to increase EPSDT awareness and compliance.
• May assist with EPSDT policies/procedures and completing service authorizations.

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree