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LPN - Care Coordinator - Fort Myers, FL

UnitedHealth Group


Location:
Fort Myers, FL
Date:
05/19/2017
Job Code:
1736728
Apply on the Company Site
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Job Details


LPN - Care Coordinator - Fort Myers, FL(Job Number:709599)
Description

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm)
 
Primary Responsibilities:
  • Coordinates follow - up care appointments and/or assists in directing care to physician clinic nurse or ITC clinic and / or medical services for post - hospitalized patients and assures timely and complete communication to ITC clinics when applicable.
  • Assesses patients clinical information and effectiveness of current medical services through phone interview, following either the WellMed or Milliman specified template for the type of call being made
  • Investigates and solves problems relating to patient responses indicating continued medical problems, plan of care failures, knowledge deficits and other responses of concern
  • Provides health services counseling regarding identified patient knowledge deficits, such as dietary information, medication orders explanation, and rationale for immediate follow up with primary care physician / ITC, etc.
  • Provides members with information on how to access services within WellMed including newly identified transportation needs
  • Identifies need for non - covered services and provides options for the patient with the assistance of WellMed case manager(s) and / or social worker(s)
  • Identifies urgent issues and forwards to the case manager, case manager supervisor, case management manager, or PCP as indicated
  • Makes follow - up calls to member as necessary to resolve items identified on initial call
  • Notifies case manager if information is obtained indicating the member is using a non-participating or non - authorized provider to allow case manager to investigate and pursue either an LOA for services or to redirect services in plan, or that patient has been institutionalized
  • Develops and maintains a network of providers, contacts, staff and other customers who may be able to assist in establishing care with new patient or arranging acute care appointments
  • Provides PCP with outpatient care assessment information and documents follow - up and interventions in the Case Management Documentation System (CMDS).
Quality:
  • Identifies, documents and reports quality of care issues and provider concerns reported by the member
  • Works collaboratively with case managers to share information regarding potential catastrophic, high cost, or individual patients, and any inpatient admissions upon notification
  • Takes ownership of the total work process and provides constructive information to minimize problems, increase customer satisfaction, identify ways to improve position efficiency, and makes process suggestions to the appropriate manager
  • Strives to personally expand working knowledge of all aspects of WellMed departments and attends and contributes to UM meetings
Customer Service:
  • Performs all duties to customers in a prompt, pleasant, professional and responsible manner regardless of the stressful nature of the situation. Provides members his / her name, title and phone number
  • Returns all voicemail within one business day, and all follow up calls within one business day or as agreed upon with the member
  • Works collaboratively with the member and healthcare professionals to meet needs of patients' overall healthcare requirements
  • Interacts with all WellMed departments and case management to provide customer services and assistance in the referral process and individual needs for patients.
Compliance:
  • Provides members information regarding benefits and coverage. Is aware of general authorization guidelines, and seeks assistance in responding to questions regarding authorization from members
  • Demonstrates knowledge of health plan benefits, policies and procedures, and quality of care criteria, including review of all new and revised information on these subjects. Maintains HIPAA compliance in all communication, including but not limited to telephonic conversations with family members, mailed information and voicemails

Job Case Management
Primary Location US-FL-Fort Myers
Other Location 
Organization WellMed Medical Mgmt, Inc
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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