LTSS Service Care Manager
Centene Corporation
Oncology LPN Care Manager
Christian Care Ministry
full-time
Posted on:
Location Type: Hybrid
Location: Orlando • Florida • 🇺🇸 United States
Visit company websiteSalary
💰 $25 - $33 per hour
Job Level
JuniorMid-Level
About the role
- Works with leadership, clinical staff, key internal departments, and external customers to ensure optimum clinical outcomes for members
- Reviews and interprets members’ medical records and compares them against proprietary and evidenced-based criteria to determine eligibility for bill sharing and advocacy for additional programs and interventions; determines if the medical record documentation supports the eligibility of requested and/or billed services
- Abstracts review-related data/information accurately and timely in appropriate review systems by the appropriate means. Provides accurate and timely submission of all administrative and review-related documents to appropriate parties
- Performs ongoing reassessment of review process to offer opportunities for improvement and/or change
- Reviews requests for genetic testing to determine eligibility for sharing and implements appropriate reimbursement strategies
- Advocates for members using the Medi-Share program to meet their health care needs
- Performs case reviews, checks medical records, speaks with patients and care providers regarding treatment and collaborates with plan of care
- Reviews pre-notification of services and clinical information for care management intervention and medical appropriateness
- Performs clinical reviews paying close attention to the appropriateness of healthcare expenditures to include length of facility stays and outpatient therapy services
- Performs concurrent review and discharge planning for inpatients
- Provides for continuity of care
- Researches and assists the negotiations for LOA/SCAs for inpatients transitioning to different level of care
- Assures appropriate levels of care are received by patients
- Provides appropriate consultation and referral to intra- and interdepartmental resources to ensure members receive optimum services offered by organization
- Manages assigned clinical caseload meeting SLAs
- Performs administrative and clinical processes to ensure team and departmental goals are met
- Delivers accurate and comprehensible verbal and written communication to external customers while complying with organizational HIPAA requirements
- Maintains accurate and timely records of all communications and interventions
- Attends all required department and organization meetings
- Contributes to the exercise and expression of Christian Care Ministry’s Christian beliefs
- All other duties as assigned
Requirements
- Current unrestricted compact LPN/LVN license with sound knowledge of anatomy and physiology, medical terminology, and disease processes required
- Graduate from an accredited Diploma, Associates Degree, or Bachelor’s Degree Program required, healthcare-related degree preferred
- 2+ years of clinical experience and/or care coordination in an acute or med-surgical environment required, oncology experience required.
- 1+ years working with EMRs and medical record/abstraction of data required
- Must be proficient in Microsoft Office Suite, internet/web navigation and research required.
Benefits
- 100% paid Medical for employees/99% for family
- Generous employer Health Savings Account (HSA) contributions
- Employer-paid Life Insurance (3x salary) and Long-term Disability Insurance
- 6 weeks of paid parental leave (for both mom and dad)
- Dental - two plans to choose from
- Vision
- Short-term Disability
- Accident, Critical Illness, Hospital Indemnity
- 401(k) – up to 4% match on ROTH or Traditional contributions
- Generous paid-time off and 11 paid holidays
- Wellness plan including Financial, Occupational, Mental/Spiritual, and Physical health incentives up to $50/mo
- Employee Assistance Program including no cost, in-person mental health visits and employee discounts
- Monetary Anniversary Awards Program
- Monetary Birthday Awards
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical reviewcase managementdata abstractionmedical record reviewcare coordinationreimbursement strategieshealthcare expenditure analysisdischarge planningpatient advocacygenetic testing eligibility
Soft skills
communicationcollaborationattention to detailproblem-solvingorganizational skillsinterpersonal skillsleadershiptime managementcritical thinkingadaptability
Certifications
LPN licenseLVN license
