LPN - Patient Care Coordinator (8:30a-5p) Johnson City, TN

Job Description:

Summary:
The LPN - Patient Care Coordinator shall ensure the overall success by collaboratively working with patients, physicians, practice teams, and the health plan to integrate the key features of the medical home, as defined. Engages the member in an active role in the management of his/her disease or medical condition, as defined, and promotes member education and self-management skills. Assists in the identification of appropriate providers, facilities, and community resources in an effort to improve or maintain the member’s social, emotional, functional, and physical health status. Engages the member to assess and improve the status of current medical, environmental, and social needs. The focus of the Care Coordinator is to promote whole person health support toe h member with emphasis on establishment of routine contact with the primary care physician and facilitate specialist referrals and other care as appropriate per physician orders. Additionally works to coordinate disease registry activities, performance reporting, and regular meetings with all stakeholders regarding success or improvements within the medical home.

Approximately eighty-five percent of the work schedule time is spent with BlueCross Blue Shield of Tennessee (BCBST) membership and fifteen percent of the time allocated to data extraction, monitoring of performance metrics and cross-functional team meetings. The Care Coordinator enhances the partnership of the PCMH and BlueCross BlueShield of Tennessee by facilitating engagement in appropriate programs and services offered through BCBST to provide health support. The physician champion and/or office manager provides oversight and direction of day-to-day activities. The Care Coordinator has a collaborative relationship with the physician and the BCBST Case Management staff as dictated by the terms of the agreement between the medical home and BCBST.

The Coordinator is responsible for carrying out key functions related to the success of the PCMH program including member outreach, PCMH reporting, performance measurement, and acting as key liaison between practice and BCBST. The Coordinator will perform outreach functions, as necessary, to members identified as having chronic conditions that meet eligibility requirements for the PCMH program. This individual will assess, identify, and prioritize individual needs and builds rapport and trust. In addition, the Coordinator will review and assess the member’s available data, including clinical/claims history, outpatient treatments, inpatient treatments, emergency room visits, medications, medical benefits from electronic Medical Records (EMR), chart reviews, or other information, to assist in the monitoring and facilitation of adherence to prescribed care plans. The Coordinator will collaborate regarding opportunities for optimizing care. This individual will facilitate member understanding of the physician’s treatment plan, including but not limited to, prescriptions, refills, medical supplies, referrals, authorization of services, and when to seek care, as well as interview the member and/or family to further assess social, emotional, functional and physical health status.
The Coordinator will ensure the care plan is implemented to include: guidance in quality and cost alternatives for medications, DME, and supplies, referral and coordination to network specialists, and facilitated engagement with appropriate resources, such as a Case Manager or health coach, for ongoing condition management or wellness education and support. The Coordinator will be responsible for working with both practice and health plan to ensure OCMH implementation of appropriate processes to support NCQA PPC-PCMH recognition. This individual will acknowledge patient’s rights on confidentiality issues, maintains patient confidentiality at all times, and follows all HIPAA guidelines and regulations and further maintain BCBST and PCMH HIPAA compliance related to member records, member interaction and system access. The Coordinator will promote education by supplying information materials, directing the member to the telephonic information library, approved websites or community resources, and/or services such as Disease Management or Case Management offered by BCBST, according to the member’s contract. The Coordinator will be responsible for understanding, assisting, education, and facilitating the overall plan of care of a chronic patient; including the maintenance and promotion of preventive screening, lifestyle coaching, and on-going follow-up care. The individual will review reports as generated by PCMH and BCBST for quality improvement and appropriate care opportunities and meet on a routine basis with the cross-functional BCBST team to review metrics and discuss quality improvements.

Requirements:
Graduate of an accredited LPN program. Case management experience preferred. Must be PC literate. Proficient with Motivational Interviewing and/or other behavioral change techniques. Ability to build rapport and engage members in effective dialogue related to their treatment plan. Ability to quickly identify and prioritize member needs and provide structured and focused support and interventions. Exceptional level of critical thinking, analytical and creative problem solving skills required. Exceptional level of independence, organization, and interpersonal skills required. Proficient with team-building processes and participation in cross-functional teams.

Licenses and Certifications:
Valid and active LPN licensure in appropriate state

Work Requirements:
Shift: Day
On Call: No
Weekends: No
Travel Required: No Travel

Location:
Integrated Solutions Health Network