Dallas, TX US
Area of Interest:
Join a team where Helping Hands and Caring Hearts makes a difference! Texas Health Resources, One of FORTUNE 100 Best Companies to work for is dedicated to finding people to help us fulfill our commitment to make health care human again. We staff our exemplary hospital with health care professionals who approach every patient, every colleague, every physician and every family member with compassion. Come join us on our Journey as we rise to the next level.
Our Care Coordination Director of North Texas is seeking to hire a Care Manager LVN to join the team.
Location: Assigned clinics Southeast region, Arlington, Fort Worth, Benbrook, Azle.
Schedule Hours: Mon – Fri 8:00 – 5:00
High School Diploma/GED, Graduate of an Accredited school of practical nursing program required. Bachelors Degree in related field preferred
3Years Care coordination, ambulatory resource management, or discharge planning with
managed care population. Skilled nursing facility and/or home health experience a plus.
LVN - Licensed Vocational Nurse. Must be licensed in the state of Texas and be in good standing upon Hire. DL - Drivers License
The Care Manager – Licensed Vocational Nurse is responsible for managing THPG's primary care population for high risk and/or chronic illness patients via creation of pro-active care plans to promote effective education, self-management support, and adherence to the PCP provider's plan of care facilitating access and timely healthcare delivery to achieve cost effective optimal
quality and financial outcomes.
Skills & Abilities:
Practiced in and knowledge of Medicare Advantage and Commercial programs and benefits preferred. • Chronic disease management of diverse patient populations and/or experience in health coaching. • Excellent time management skills with
ability to prioritize tasks effectively and efficiently.
Manage High Risk (Chronically ill and/or Medically complex/fragile) patients via Longitudinal Care
Prioritize patients via risk stratification tool, providers referrals, inpatient discharge hand offs, and departmental team referrals
Conduct assessments via EMR review and patient interviews for care plan that identifies and addresses barriers to PCP plan of care adherence documenting goals in EMR
Pre-service and concurrent reviews are performed when members are receiving home health services to ensure that care is provided in accordance with evidence-based guidelines.
Facilitate coordination of specialist utilization in collaboration with PCP
Coordinate services with third party payers such as Transition House Calls (THC), Home Health (HH), Social Worker Consult (SW), and other team members
Performs audit of initial and concurrent home health cases
Determines medical necessity and appropriateness of services using clinical review criteria.
Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information
Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Telephonic discussion with health care providers and/or members to explain benefit coverage determinations and to obtain additional clinical information
Appropriately identifies and refers cases that do not meet established clinical criteria to PCP and forwards to Medical Director if indicated
Recommendation of multidisciplinary team care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care
Utilize both company and community-based resources to establish a safe and effective case management plan for members
Interacting with Medical Directors on challenging cases
Function as a member of an interdepartmental team to meet specific individual and team performance metrics.
Coordinates with members of the health team for the overall interdisciplinary action plans for Home Health from initial certification to discharge
Collaborates with PCP and practice team members,
Collaborating with Medical Directors, primary care physician, and non-clinical partners
Collaborates with patient’s home health provider, patient, family, internal care coordination team, and primary care services for recommendation
Identify and initiate referrals for other team members
Recommends and assists with the coordination of interdepartmental interdisciplinary care services for assigned patients
Participate in Interdisciplinary team meetings and care management rounds providing information to assist with safe transitions of care
Acts as an interdepartmental liaison to ensure prompt resolution of home health case management issues
Serves as the accountable point of contact to facilitate, coordinate and evaluate the ongoing HHCM case recommendation throughout the Continuum of PCP approved HHCM plan
Acts as a resource for others with less home health experience
Documents all recommendations; interventions in appropriate Provider EMR and Care Coordination platform
• Responsible for organizing and planning training/education for assigned providers and administrative staff on Home Health Medical Necessity methodology ensuring that the training is appropriately integrated into the care coordination strategic direction as well as the missions and values of SWHR population health services.
Will provide both formal as well as individualized training/education on Home Health guidelines in compliance with company and regulatory standards to ensure that compliance and optimization is established across the organization
Will identify areas that need improvement and organize monthly or as needed training sessions with assigned providers and/or their administrative staff
Will identify and provide feedback on home health EMR documentation standards for support of validation of home health services
Texas Health Resources is one of the largest faith-based, nonprofit health care delivery systems in the United States and the largest in North Texas in terms of patients served.
Texas Health has 25 acute-care and short-stay hospitals that are owned, operated, joint-ventured or affiliated with the system. It has more than 3,800 licensed beds, more than 21,100 employees of fully-owned/operated facilities plus 1,400 employees of consolidated joint ventures, and counts more than 5,500 physicians with active staff privileges at its hospitals.
At Texas Health, we strive to create an atmosphere of respect, integrity, compassion and excellence for all who come in contact with us, be they patients or our employees. We are committed to diversity in our workforce, and our mission to serve spreads across ethnic, cultural, economic and generational boundaries. We invite you to join us in furthering your career through our accomplishments and philosophy of excellence.