Population Health Lvn Case Coordinator

We appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will help us potentially place you in a position that meets your objectives and those of the organization. Qualified applicants are considered for positions without regard to race, color, religion, sex (including pregnancy, childbirth and breastfeeding, or any related medical conditions), national origin, ancestry, age, marital or veteran status, sexual orientation, gender identity, genetic information, gender expression, military status, or the presence of a non-job related medical condition or disability (mental or physical).
KHS reasonably expects to pay starting compensation for the position of Population Health Management LVN Case Coordinator in the range of $30.20 - 40.05 hourly.
Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system.
Primary Purpose
Under the direction of the Kern Health Systems Director of Population Health Management, PHM Manager and Supervisor, the LVN is responsible for the execution, coordination, and facilitation of members' individualized plan of care in collaboration with members, families, caregivers, and other health care providers. The LVN uses their clinical judgment to determine a member's needs and gaps in care. The position provides support, guidance, education, and acts as a liaison between the member's PCP and specialty physicians to maximize health outcomes and prevent unnecessary hospitalizations. This role also supports a variety of care programs, outreach, education, quality improvement, and other initiatives as needed.
Class Characteristics
Conducts medical necessity review of referral requests. Utilizes Milliman and Medicaid criteria to facilitate decision making. Refers cases to the KHS Medical Director when clinical information does not support medical necessity. Utilizes the RN PHM Case Manager as a key resource for questions or clarifications on case management and coordination, eligibility/criteria, interpretation of benefits, or whenever needing additional clinical expertise and/or guidance.
Supervises: No
Essential Functions

• Facilitate screenings, intakes, and maintain other required documentation in electronic medical record.
• Provide care coordination on moderate and low risk patients.
• Use all components of the Transition of Care model and nursing process including planning, implementing, and evaluating care to meet the members' needs.
• Provide health maintenance, medication, and disease management education to members and families/caregivers.
• Coordinate appropriate patient care appointments, community resources, referrals, management program benefits.
• Ensure member's preventive care appointments are scheduled and encourage member to participate in those appointments.
• Ensure implementation of health risk assessments, care plans, and interdisciplinary care team actions/recommendations.
• Responsible for updating the care plan based on care coordination activities for members open to case management.
• Present and participate in Interdisciplinary Care Team.
• Shares information as necessary with appropriate staff in Population Health Management, Disease Management and Utilization Review.
• Collaborates with the KHS Member Service Department and the Provider Relations
• Keeps current with California Children's Services benefits and guidelines for coordination of services.
• Conduct ongoing follow-up with members, family and/or family caregiver in the evaluation of care coordination activities.
• Take an active role in coordinating and initiating member's access to Kern Health System programs and resources.
• Effectively communicates, problem-solves, and maintains productive and effective interpersonal relationships while effectively prioritizing patient care.
• Supports members and their families/caregivers and provides compassionate care.
• Make referrals / linkages to community resources on an individualized basis.
• Other duties as assigned.

REQUIREMENTS:
CORE COMPENTENCIES / KNOWLEDGE & SKILL REQUIREMENTS

• Lead by example to support a positive work environment that values patient advocacy, respectful listening, diverse expression of opinion and constructive conflict resolution;
• Adheres to KHS's Code of Ethics and Business Conduct and all company policies; e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance and demeanor;
• Represent KHS in a positive manner to all members, caregivers, staff and external stakeholders;
• Demonstrate commitment to continuous improvement;
• Strong knowledge of acute chronic care nursing principles, methods and common treatments;
• Strong knowledge of common human diseases and usual and customary methods of treatments;
• Demonstrated knowledge of medical terminology;
• Ability to effectively evaluate medical records to determine appropriateness and necessity of care;
• Demonstrated knowledge of health care delivery systems;
• Demonstrated knowledge of Population Health management, social determinants of health and health equity;
• Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individual at all levels both inside and outside of KHS;
• Ability to use tact and diplomacy to diffuse emotional situations;
• Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards;
• Intermediate skills in Word and Excel with basic ability to enter data into and navigate through a database;
• Demonstrated ability to respect and maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with activities conducted in, or related to, patient healthcare, KHS business or employee information and make no disclosure of such information except as required in the conduct of business;
• Demonstrated ability to commit to and facilitate an atmosphere of collaboration and team work;
• Self-directed, with proven ability to work independently with minimum supervision;
• Demonstrated ability to multi-task in an interrupt-driven environment and complete assignments on a timely basis;
• Strong attention to detail; work accurately and at a reasonable rate of speed;
• Compliant with KHS policies and procedures; performs the job safely and with respect to others, to property, and to individual safety.

EDUCATION, EXPERIENCE & TRAINING REQUIRED:

• Licensed Vocational Nurse LVN with an active, current, unrestricted license

• Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required;
• Experience working with patients and caregivers regarding self-care and disease management required;
• Experience working in case management or care coordination is a plus;
• Knowledge of Kern County Community resources for seniors and people with disabilities is a plus.

OTHER REQUIREMENTS:

• Valid California Driver License
• Bilingual (English/Spanish) preferred

We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis.
Other details

• Pay Type Hourly
• Min Hiring Rate $30.20
• Max Hiring Rate $40.05
• Travel Required No
• Travel % 0
• Telecommute % 0
• Required Education Associate Degree

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