We are eager to add an enthusiastic Telephonic Licensed Practical Nurse - OH - On Site to join our talented team at Vensure Employer Services in Worthington, OH.
Growing your career as a Full-Time Telephonic Licensed Practical Nurse - OH - On Site is a remarkable opportunity to develop key skills.
If you are strong in presentation, adaptability and have the right attitude for the job, then apply for the position of Telephonic Licensed Practical Nurse - OH - On Site at Vensure Employer Services today!
About Us
Vensure Employer Solutions is the largest privately held organization in the HR technology and service sector, providing a comprehensive portfolio of solutions, including HR/HCM technology, managed services, and global business process outsourcing (BPO). The company and its service providers collectively serve over 95,000 businesses and process over $135B in annual payroll. As a "One Employer Solution” headquartered in Chandler, Arizona, Vensure helps thousands of businesses streamline and grow their operations with custom strategies that benefit both employers and employees. Find out more by visiting www.vensure.com
Position Summary
The Licensed Practical Nurse works with patients, providers, and Plan sponsors to meet the patient's health needs through communication and available resources to promote quality cost-effective outcomes via the medical management process. The Licensed Practical Nurse will have a high degree of clinical skills and will be capable of assisting with the assessment and planning for selected or referred patients, under the supervision of a Registered Nurse Medical Manager. The Licensed Practical Nurse will collaborate with the patient, family as appropriate and necessary, physician and other members of the healthcare team, to facilitate and coordinate healthcare services utilizing the patient-centric medical management process to set priorities, plan, organize, and implement interventions; provide utilization management services; and provide patient education and support. The Licensed Practical Nurse will coordinate the delivery of high quality, cost-effective care based on a medically necessary and appropriate plan of care supported by evidence-based clinical practice guidelines established by nationally recognized authoritative bodies, and educate patients as needed to promote appropriate compliance with medically directed treatment plans, and maintain a healthy lifestyle. The process known as "Patient-Centric Comprehensive Care Management” (P3CM) at AIMM combines case management, disease management, and utilization management processes as needed by individual patients who are identified as in need of services to regain health and/or optimize health.
Essential Duties and Responsibilities
- Utilize the P3CM process for member-specific assessment, education, planning, goal setting, facilitation and coordination of medically necessary and appropriate health care services, moving the member toward higher levels of self-care as appropriate; Medical Management Nurses are responsible for reviewing and understanding the scope of practice of their state of licensure and practicing case management and utilization management within that scope of license.
- Document accurately and comprehensively the assessment and plan of care as outlined by the URAC Case Management Organization Standards;
- Document case notes and other activities accurately and comprehensively in a professional manner;
- Negotiate price, level of care, intensity and duration of services.
- Provide utilization management/review services for cases using evidence-based clinical practice guidelines.
- Interact and communicate, by telephone in a professional manner, striving for continuity and efficiency as the member is managed along the continuum of care;
- Implement fiscal accountability, understand its impact on resources; and be able to perform financial analyses;
- Implement, monitor and evaluate the patient's plan of care on an ongoing basis, moving the member toward goal accomplishment and/or higher levels of wellness;
- Evaluate health care services offered and provided by members of the health care team, analyze variances according to evidence-based clinical practice guidelines, and participate in the quality improvement processes to enhance and improve AIMM's medical management services and member outcomes;
- Demonstrate sensitivity to culturally diverse situations, patients, and customers.
- Under the supervision of a Registered Nurse Medical Manager, provide quality, cost effective medical care management for members with catastrophic and chronic illness/injuries..
- Remain current with alternative resources and treatments in outpatient and alternative care settings.
- Support training initiatives as assigned.
- Participate in the Quality Management Program/Committee as requested.
- Responsibility for maintaining ongoing availability to and monitoring and oversight of non-clinical staff.
- Will perform other duties, consistent with their education and training, as assigned.
- Will consistently demonstrate an ability to exceed minimum productivity and audit standards.
- Will demonstrate efficiency in handling calls. General expectations are as follows:
- Fewer than 4% of calls will exceed 12 minutes in duration
- Fewer than 22% of calls will exceed 6 minutes in duration
- Supervisor screening of calls will result in fewer than 20% of screened calls having process improvement comments and/or revisions required
- Will demonstrate that content of conversations is meaningful and robust and that a relationship has been quickly and efficiently established with the patient
- Fewer than 20% of calls will be shorter than 2 minutes in duration
- Appropriate clinical criteria will be referenced in all activities which are conversations with a patient or their designated representative
- Will demonstrate, through work completed, a team work attitude in completing all necessary activities associated with the job as demonstrated by:
- At no time shall the volume of either inbound and/or outbound calls be less than 1/3 of the total volume of calls touched (demonstrates that the RN is doing both inbound and outbound in reasonable proportion)
- There shall be no tickles/assignments left at the end of an individual employee's shift which were assigned specifically to that individual or which were generated by that individual as the result of a conversation completed with a patient which identified additional needs.
Knowledge, Skills, and Abilities- Employ analytical thinking;
- Knowledge of functional tasks performed within the medical management department;
- Knowledge of self-funded Plans;
- Computers and Microsoft Office software packages
- perform duties in an ethical manner;
- Prioritization, research and decision-making skills;
- Strong analytical skills and ability to report findings in an accurate manner.
- Understand business management theory and practices;
- Manage change;
- Prioritize, analyze, and negotiate multidirectional communication for consensus;
- Commit to quality medical management and healthcare service(s);
- Be self-directed in a responsible manner;
- Work as part of a team;
- Utilize technology in a professional, proficient manner
- Demonstrate excellent time management, organization, prioritization, research, analytical, negotiation, communication (verbal and written) and interpersonal skills;
- Effectively manage multi-task functions.
Competencies specific to the Medical Management Nurse also include
- Interaction competencies:
- Communication
- Assertiveness
- Negotiation
- Analytic competencies:
- Assessment (holistic)
- Problem identification and evidence demonstrating resolution Evidence-based Clinical Practice Guideline identification and application
- Planning:
- P3CM medical management processes
- Identification of member-specific short and long term goals
- Resource identification and utilization
- Discharge planning across the continuum of care
- Implementation:
- Identification of medical management action steps designed to implement and facilitate the Case Management Plan
- Facilitation and coordination of medical treatment plan
- Advocacy for member needs;
- Counseling, teaching and coaching
- Evaluation and Monitoring
- Documentation
- Quality Assurance
- Cost containment
Education & Experience- Current licensure as a Licensed Practical Nurse in the State in which he/she resides; and Three (3) years of clinical practice experience in one of the following areas, or a combination of 5 or more years in the following areas:
- Acute Care, medical/surgical
- Specialty care areas
- Long-term care
- Home health care (preferably high technology)
Benefits of working as a Telephonic Licensed Practical Nurse - OH - On Site in Worthington, OH:
● Excellent benefits
● Room for Advancement
● Advantageous package
Salary :
No CV Required
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