Case Manager LPN

WVU Medicine

2d

About The Position

This position provides support assistance to the Case Manager and Appeal Specialist as assigned. The Care Facilitator will perform duties that include insurance determinations, third party payer authorizations and other clinical aspects of case management to improve patient care across the continuum of the patient stay and discharge.

Requirements

• Current Licensed Practical Nurse license issued by the state in which services will be provided or current multi-state Licensed Practical Nurse license through the enhanced Nurse Licensure Compact (eNLC).
• Knowledge of insurance and authorization processes.
• Knowledge of patient discharge needs and local community resources.
• Knowledge of patient’s current medical insurance coverage and limitations and the precertification requirements for Durable Medical Equipment (DME), post-acute placements, infusions, transfers etc
• Frequent sitting, standing, walking, reaching.
• Ability to lift and carry up to 10 pounds.
• Working closely with others.
• Working around biohazards and infectious diseases.
• Working with electrical hazards associated with patient care equipment.

Nice To Haves

• Two (2) years clinical experience in the acute care setting.

Responsibilities

• Utilize Interqual Criteria to assure the appropriate level of care is determined in order to receive appropriate third party payer authorizations with required time frames. Base on direction from the Case Manager, will continue to provide clinical support in communication to third party payers throughout the patient stay. Will provide preparation of the daily work for the Case Manager as appropriate. Will provide coordination of physician communication to streamline daily contact.
• Assists in managing the continuum of care from admission through discharge. In collaboration with Social Services, will facilitate cost effective/appropriate management of patient cases or discharge planning, medication authorizaton and other home/transfer needs based on the patient's plan of care. Assist Case Manager to obtain authorization for post-acute care services including SNF, DME and Home Health Care.
• Participate in patient care conferences, daily rounds and family conferences as directed by the Case Manager.
• Assists Case Manager with problematic cases and patient care issues required research and fact finding.
• Audit inpatient Case Management for appropriate documentation including admit orders, length of stay certification and documentation medical necessity.
• Collects quality and utilization date as assigned by management personnel and Appeals Specialists.
• Assists with preparation of materials related to teleconferences, readmission reviews, denials and appeals.
• Maintain education and licensing requirements as determined by the Director of Case Management.
• Additional duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees