Case Manager Assistant / LPN
范围：案例管理助理协助 RN 案例管理人员执行必要的功能，使用案例管理过程以满足 MedWatch LLC 客户和消费者的需求。包括但不限于：授权服务，审查医疗必需品治疗计划，护理标准以及与卫生保健团队的所有成员持续沟通。案例管理副主任在 RN 案子管理员直接管理和监督下完成所有职能。这是远程 （从家工作）执照要求：· 执照护士 （目前在美国或其领土内，现有实践和居住状态下活跃且无限制）教育，培训和专业能力：优先获得许可证的实践护理教育。基础计算机技能经验：· 5年多种临床经验，或者3年的专业领域；责任：· 案例管理助手将在其执照范围内的实习。案例管理助理将在 RN 案例管理人员的直接监督下工作，并按照总干部指令执行案件管理职能，不包括初步病例评估和初始护理计划的制定。·审查可提供的所有医疗数据以更新一个案例管理计划，其中将包含与服务提供者，付款人，患者和病人的主要护理人员的联系。·与支付机构联系，了解任何影响行动计划的利益限制。· 联系医疗保健提供商和设备供应商，以验证已订购的护理或设备的医疗必要性。·根据患者的需求，医生条例和可用的好处安排治疗。· 了解任何可能使病人达到健康目标的替代治疗可能性。如果你建议的替代疗法没有好处，请向付款人提供成本效益分析，以证明外合同服务将改善患者的医疗状况并对福利计划具有成本效益。·了解社区资源和资金来源，以便患者获得优质的医疗保健并节省健康福利。许多机构提供援助给患者
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Scope:
The Case Manager Assistant assists the RN Case Manager in performing necessary functions using the case management process in order to meet the needs of the MedWatch, LLC customers and consumers. This includes, but is not limited to: authorization of services, review of treatment plans for medical necessity, standards of care, and ongoing communication with all members of the health care team. The Case Manager Assistant performs all functions under the direct management and supervision of the RN Case Manager. This is a Remote (work from home) position.
License Requirements:
· Licensed Practical Nurse (current active and unrestricted, in current state of practice and residence, within the United States or its territories) Education, Training and Professional Competencies: Licensed Practical Nursing Education preferred. Basic Computer skills
Experience:
· 5 years of varied clinical experience preferred, or three years in a specialty field.
Responsibilities:
- The Case Manager Assistant will practice within the scope of his/her licensure. The Case Manager Assistant will operate under the direct supervision of the RN Case Manager, and perform case management functions as directed by the CM, excluding Initial Case Assessments and Formulation of the Initial Care Plan.
- Review all medical data which can be provided to update a case management plan which will incorporate contact with providers, payers, with the patient and with the patient’s primary caregiver.
- Make contact with the payer office to find out and understand any benefit constraints that will have an impact on the plan of action.
- Proceed with contacting medical care providers and with equipment vendors to verify medical necessity of care or equipment that has been ordered.
- Make care arrangements for quality patient care according to the needs of the patient, the physician’s orders and the benefits available.
- Be aware of any alternative treatment possibilities that may allow the patient to reach wellness goal(s). If there are no benefits available for your recommended alternative treatments, provide to the payer a cost-benefit analysis to demonstrate that extra-contractual services will enhance the patient’s medical condition and will be cost-effective to the benefit plan.
- Become familiar with community resources and funding sources so that the patient can receive quality health care and conserve health benefit dollars. Many agencies exist which provide assistance to persons in financial need or to provide information to persons with specific medical conditions.
- Maintain case in computer system documenting case actions for each patient under your Assigned Case Managers caseload, under direction of the Case Manager. Complete all aspects of case in the computer. Prepare timely reports to the payer to detail all case actions, the results of those actions, and the continuing case management plan, which are reviewed by the Case Manager.
- Maintain billing as appropriate in computer system.
- Continue to maintain contact with the providers and with the patient across the continuum of care to be sure that patient needs are being met. On any cases which include a chronic condition keep the file open for periodic contacts to verify the clinical status of the patient and additional medical needs.
- Negotiate with providers to maximize the medical benefits available to the patient. Make network referral as appropriate.
- Act upon any awareness of non-medical issues which involve the patient’s safety or welfare. Attempt to direct the patient or family to appropriate providers or community resources, or to personally notify appropriate authorities in consultation with the Case Manager.
- Consult with the Case Manager on a regular basis, and keep the supervisor informed regarding any complaints which may occur about case management services or any issues which arise which the case manager assistant is not competent to handle, or does not have the expertise to handle.
- Adhere to all company policies as stated in the employee handbook.
- Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers.
Work Environment / Physical Demands: This position is in a typical home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.
The salary range for this position is from $23 to $27 per hour.We are an Equal Opportunity Employer, including disability/veterans.
Originally posted on Himalayas