Preservice Review Nurse LPN or LVN
Optum
2024-09-23 11:40:17
Lincoln, Nebraska, United States
Job type: fulltime
Job industry: Healthcare & Medical
Job description
4C Medical Group, part of the Optum family of businesses, is seeking a LPN to join our team. Optum is a clinician-led care organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.
At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
The Preservice Nurse (LPN/LVN) will collaborate with medical directors, nurses and clinical coordinators and communicate, via telephone or secure video, with the supervising provider. The provider will direct the evaluation and care provided. You will work out of a queue and generate letters based on the specific need. All activities will fall within the employee's scope of practice as set by the State they are practicing in.
Hours: Monday-Friday 8am-5pm in their time zones they reside
If you are located in either Pacific Standard or Mountain standard time zones, you will have the flexibility to work remotely as you take on some tough challenges.
Primary Responsibilities:
- Researches member benefits and eligibility
- Completes all assigned cases within required timeframes (TAT)
- Processes and documents all case activities per SOPs and DES
- Prepares and documents clinical case review and assigns to Medical Director for Medical Director (LTAC, AIR and SNF) decision
- Communicates and documents Medical Director determinations to providers and members.
- Maintains communications with providers for continuity of care and completion of ALOC requests
- Prepares case information for assignment to National Letter Team
- Submits requested Contract Exceptions for SNF cases
- Educates providers, members and internal staff on guidelines, member benefits, alternate levels of care available
- Acts as a clinical resource to non-Clinical staff
- Collaborates with other internal stakeholder's/departments for member's appropriate level of care: Medical Director, Optum/United Nursing Home members, Appeals and Grievances, National Letter team, and Intake/CDU
- Performs self-audits to assure compliance with SOP DES
- Works within HSR, InterQual and, multiple SharePoint sites
- Participates in compliance meetings, process improvement planning
- Reports individual case concerns to manager, Medical Director as needed
- Triage cases received from IPC
- Assigns cases to Facility ICM or other work groups
Required Qualifications:
- High School Diploma/GED (or higher)
- Current, unrestricted LVN/LPN license in the state you reside
- 3+ years of experience in Case Management
- Intermediate level of proficiency with Microsoft Excel including the ability to quickly learn Clinical Applications
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
4C Medical Group was founded in 2002 by the late Dr. Vishal Chaurasia with a simple yet powerful idea of improving patient care through effective communication and collaboration between healthcare providers. With a goal of reducing fragmentation in care as patients move from one care-setting to another, we built our care delivery model around the idea of being able to follow patients no matter which care setting they were in while keeping the patient's primary care physician at the core of the care delivery system. With a mission of helping people live healthier lives and helping the health system work better for everyone, Optum is the leading provider of Value-Based care in the country. Together, as Optum, we are building the premier physician-driven and patient-centric healthcare organization in Arizona.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.