High Risk Maternity Nurse Case Manager Jobs (NOW HIRING)

Position Type Full Time Category Managed Care

General Summary: The LVN Case Manager focuses on providing quality and continuity of care for our patients while reducing utilization costs. Responsibilities for this position include directing patients to timely, appropriate healthcare services based on the patients' symptoms and medical conditions via phone. Providing Case Management services to GMG capitated patient that focuses on providing care for patients who are high risk for frequent inpatient or ER encounters, and/or patients who need added expertise to guide them through a complex treatment plan.

Supervisory Responsibilities: This position has no supervisory responsibilities.

General Requirements: All duties performed will be done accurately and in a timely manner.

1. Develop and maintain supportive, productive, and effective relationships with external and internal partners.
2. Must have excellent written and verbal communication skills.
3. Strong attention to detail and exceptional organizational skills.
4. Maintain strict confidentiality of company, department, and patient information.
5. Other duties as assigned.

Essential Job Responsibilities:

1. Assist in directing patient to the appropriate level / location of care. Based on history, symptoms, and provider advice by appointing patients with a GMG Provider, directing patients to Urgent Care or an Emergency Room, as needed, providing standard advice or provider's specific directions to patient.
2. Following approved triage protocol guidelines set forth by the organization.
3. Maintain accurate database of GMG High Risk patients. Review High Risk census weekly to ensure it reflects appropriate high-risk patients, those who frequently have hospital admits/ER visits, and other highest risk patients for case management.
4. Stratify patients in team meetings to define care needs and frequency for home visits by our High-Risk nurses or licensed Social Worker.
5. Place timely calls to high-risk patients to assess their health status, ensure the treatment plans are being carried out, perform teaching, and monitor outcomes.
6. Arrange appropriate acute care and follow up care with PCP, Intake, and other GMG Providers or Preferred Providers.
7. Assist patients with medication orders, refills, diagnostics, and other services identified during the process.
8. Educate patients in relation to the disease process, symptoms, treatments, and provider orders.
9. Keep PCP, clinical and high-risk care team members informed of pertinent findings/issues.
10. Update daily hospital census.
11. Participate in physician communications (email, meetings, etc.) to keep tabs on clinical picture/plan for patient.
12. Ensure that patients have prompt Hospital Follow up appointments to help prevent readmission. Assess discharge status, level of understanding and compliance; monitor attendance/ follow up on 'no shows and cancellations.
13. Attend Patient Care Committee and High-Risk Team meetings to provide follow up case management and other special care needs defined during PCC and HR Mtgs.
14. Assist with other patients as needed to set up complex services that are needed acutely: SNF, Custodial Care, Psychiatric services, IV treatments, etc.
15. Review HH/DME forms and ensure services are authorized before the provider's sign/fax.
16. Document appropriately in GMG computer systems, high risk database and other associated systems.
17. Successfully meet care coordination and nurse triage production goals.

Education and Training: Minimum high school education or equivalent required. Graduation from an approved practical nursing program. Must be state-licensed practical nurse with one year of LVN and clinic experience preferred. Must keep all licenses and certifications current and in good standing as initial and continued employment is contingent up these credentials.

Experience: Experience in a clinic, doctor's office or hospital as a LVN for at least three years required.

Must have knowledge of medical terminology, anatomy, physiology. Familiarity with health care systems, regulations, policies, and functions. Must have a good understanding of documentation standards.

Other Requirements: Computer Skills : Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.

Work Environment: Depending upon the area assigned may be 100% clinical setting or office setting in a clinic environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.

Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.

Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.