The LVN/LPN is responsible to conduct medical necessity screening and work collaboratively with the interdisciplinary team to provide care coordination for patients under the direction of a Registered Nurse and in compliance with evidence-based practice and regulatory requirements. This position complies with the scope of services defined by the Licensed Vocational /Practical Nurse LVN/LPN state licensure requirements. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction. Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care. Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy. Education provided to physicians, patients, families and caregivers.
The individualâs responsibilities include the following activities:
Accurate medical necessity screening and submission for Physician Advisor review
Implementation of the transition plan based on RN Case Manager and/or Social Worker (SW) assessment(s)
Communication with interdisciplinary team during patient care conferences
Management of concurrent disputes
Communication with patients and families regarding the plan of care established by RN, SW and Physician
Collaboration with physicians, office staff and ancillary departments
Clear, complete and concise documentation in electronic system
Maintenance of accurate patient demographic and insurance information
Identification and documentation of potentially avoidable days
Identification and reporting of over and underutilization
And other duties as assigned
Required: 2 years patient care experience
Required: Must be currently licensed, certified or registered to practice profession as required by law, regulation in state of practice or policy.
Job: Case Management/Home Health
Primary Location: San Antonio, Texas
Facility: Baptist Health System
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâs or employeeâs race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 1805045573
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Case Management Society of America 6301 Ranch Drive Little Rock, AR 72223