Remote Lpn Utilization Review Jobs in Rochester, NY

The Licensed Practical Nurse, Health Plan Health Support is integral to the Care Management team to triage calls that need urgent follow-up and resolution and to educate, coordinate, and track preventative care with health plan members. This position is a fully remote position (with periodic travel to the office closest to your geographic location).

Performance Responsibilities and Standards

1. Respond to incoming calls to the Care Manager with the goal of one call resolution or resolution within the same day.
2. Assist and consult members and providers over the phone.
3. Gather necessary information if the call needs escalation to Care Manager or supervisor.
4. Contacts health plan members who require preventative care, including immunization, health screenings, and recommendations to reduce hospitalizations and improve safety in the home to provide clinical guidance, education, and support in conjunction with Care Manager.
5. Review health plan reports and member records to identify members who need appropriate annual wellness visits or preventative health care.
6. Schedule and coordinate preventative health care with providers within the required time frames.
7. Coordination of necessary transportation for wellness or preventative health appointments.
8. Document all communication in health plan electronic medical record.
9. Update member’s records in EMR by uploading health maintenance documents from external sources (immunizations, screenings, consultations, etc.).
10. Collaborating with Care Management Team if preventative health care coordination efforts are unsuccessful.
11. Demonstrate compassion, collaboration, communication, and appropriate member-care judgment.
12. Assist in maintaining compliance with quality assurance standards and engage and support members to ensure they feel heard, respected, and involved in their care.
13. Ability to move through multiple management systems simultaneously.
14. Other duties as assigned to assist in the Care Management of health plan members.
15. This is a remote position; however, the LPN must live within Upstate New York.

Qualifications:

1. Licensed Practical Nurse with current NY Licensure and resides in NYS
2. Two years minimum clinical experience and/or
3. Two years minimum experience in an Outreach setting, Managed Care, Case Management, Ambulatory clinic setting, or related field.
4. Working knowledge of Microsoft Office applications such as Excel and Word.
5. Familiarity with Mediture/Truchart or other EMR systems, HealtheConnections (or other RHIOs) and Zoom, Microsoft Teams.

Requirements:

1. 1. Proficient computer and typing skills.
   2. Excellent verbal and written communication skills with the ability to clearly communicate test results and document legibly.
   3. Interpersonal skills necessary to interact effectively with patients, team members, and physicians and to maintain team-oriented relationships with senior management, managers, and staff.
   4. Ability to work efficiently with minimal supervision while exercising attention to detail and independent judgment within stated guidelines.
   5. Ability to maintain high customer service standards.
   6. Proficient computer skills and the ability to learn and effectively utilize department-specific software systems.
   7. Ability to effectively perform or learn technical skills to perform essential functions within an allocated time frame.
   8. Ability to work a flexible schedule as part of a team.

Physical Requirements

• Ability to sit or stand at a desk 90% of the day
• Visual/hearing ability sufficient to comprehend written or verbal communication
• Ability to express self verbally and in writing
• Must be able to engage in real-time phone communication with clients, caregivers, and providers as a core job function.
• Frequently uses a laptop computer to enter orders and obtain product information
• Bloodborne Pathogens Exposure Category III - Employee who rarely has contact with blood and body fluids

Compensation & Benefits

Competitive Salary [This position is an H07 non-exempt position with a min-max rate of: $21.36- $26.70/hour] with:

• 401K with generous Employer match
• Retention bonuses
• Internal mentoring program
• On-Site Gym (free for all employees)
• Medical, Dental, Vision plans
• Tuition Reimbursement for BSN after 6 months of employment
• Exceptional work/life balance - no rotating shifts
• Partially funded HSA
• Employee Recognition Platform
• Paid Time Off, Holidays, and Extended Sick Leave
• Short/Long term Disability
• Employee Assistance Program (EAP)
• Much More!!

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About Nascentia Health:

Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.

Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.

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Nascentia Health is an Equal Opportunity Employer (EOE)

Employment is contingent upon negative results of a pre-hire drug screen