Case Manager Assistant / LPN

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 or Medical Assistant/Nursing Assistant Certification (current active and unrestricted, in current state of practice and residence, within the United States or its territories)

Experience

• 5 years of varied clinical experience preferred, or three years in a specialty field.

Responsibilities

• Practice within the scope of his/her licensure and operate under the direct supervision of the RN Case Manager, performing case management functions as directed by the CM, excluding Initial Case Assessments and Formulation of the Initial Care Plan.
• Review all medical data to update a case management plan, incorporating contact with providers, payers, and the patient and their primary caregiver.
• Contact payer offices to understand benefit constraints impacting the plan of action.
• Contact medical care providers and equipment vendors to verify medical necessity of care or equipment ordered.
• Make care arrangements for quality patient care according to patient needs, physician orders, and benefits available.
• Be aware of alternative treatment possibilities and provide a cost-benefit analysis if benefits are unavailable for recommended alternative treatments.
• Familiarize oneself with community resources and funding sources to ensure patients receive quality health care and conserve health benefit dollars.
• Maintain case documentation in the computer system, completing all aspects of the case and preparing timely reports to the payer detailing case actions, results, and the continuing case management plan.
• Continue contact with providers and the patient across the continuum of care to ensure patient needs are being met. For cases involving chronic conditions, keep the file open for periodic contacts to verify patient's clinical status and additional medical needs.
• Negotiate with providers to maximize medical benefits available to the patient and make network referrals as appropriate.
• Act upon any awareness of non-medical issues affecting the patient's safety or welfare, directing the patient or family to appropriate providers or community resources, or notifying appropriate authorities in consultation with the Case Manager.
• Consult with the Case Manager regularly and keep the supervisor informed about any complaints regarding case management services or issues the Case Manager Assistant is not competent to handle or lacks expertise to address.
• 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.

Pay

The salary range for this position is from $23 to $27 per hour.

Equal Opportunity Employer

We are an Equal Opportunity Employer, including disability/veterans.