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Addison Group

Patient Care Coordinator - Remote

3+ months agoHouston, TX

Patient Care Coordinator-Remote
-up to $60,000/year based on experience

-must have a nursing diploma and be a certified LPN or LVN
-can be located anywhere in the United States with a remote work space

  • Responsible for utilization review and assisting with discharge planning activities (i.e.: DME, home health services) for members enrolled with a line of business, and monitoring the delivery of healthcare services in a cost effective manger
  • Maintain knowledge of state and federal regulations, State Contracts and Provider Agreements, benefits, and URAC standards
  • Prospective and retrospective review of elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment
  • Coordinate care and facilitate discharge to an appropriate level of care in a timely and cost-effective manner
  • Identify and refer quality issues to Quality Improvement
  • Identify and refer appropriate members for Care Management
  • Document and communicate with Provider Care Managers and Discharge Planners to establish discharge planning needs and coordinate care
  • Provide guidance to non-clinical medical management staff
  • Perform any other job related instructions, as requested

  • Nursing Diploma (LPN) required
  • Minimum of (3) three years' medical/surgical acute care or clinical experience required
  • Two years' utilization review and/or case management experience preferred
  • Experience with Medicaid, Medicare, Commercial and Managed Care preferred

IND 004-007

Job ID: AddisonGroup-491067
Employment Type: Other