Patient Care Coordinator - Remote

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