LPN Care Coordinator with Skilled Nursing Experience (Fully Remote) (Spanish Speaking Required) Overview: The Care Coordinator is responsible for developing and providing care coordination services directly to Alopex clients’ patients. Reports To: RN Supervisor Department: Clinical Operations Job Description: As an LPN Care Coordinator, you will play a pivotal role in managing and coordinating care for patients enrolled in Alopex’s services. You will work closely with patients, primary care providers, and other specialists to develop, implement, and monitor individualized care plans. Your goal is to ensure that patients receive the highest level of care through ongoing communication and coordination. - Conduct a detailed review of EMR records. - Develop and maintain individualized Care Plans for management of patients. - Implement and coordinate all care management activities relating to patients across the continuum of care. - Communicate with the patient’s clinical care team. Care management must be performed in a timely manner. - Monitor patient progress toward desired outcomes through assessment and evaluation. - Maintain accurate and detailed documentation related to medication, problems, goals, interventions, preventative care, etc. - Conduct monthly care calls to the patients enrolled in the program. - Address all needs/concerns including any follow up needed for patients. - Educate patients on chronic conditions and reinforce the provider’s directions related to chronic conditions. - Evaluate and address social determinants to health and begin to link community resources; then, enter them in the system. - Evaluate/assess medical conditions and be able to identify and address changes in a clinically appropriate manner. - Adhere to all policies & procedure as outlined by Medicare and Shifox/Alopex - Perform other duties as assigned. Qualifications and Skills Required: - Bilingual (English/Spanish) Required - Possess a minimum of two (2) years’ experience providing patient-centered care. - Possess a minimum of one (1) year experience in skilled nursing. - Have experience working with electronic medical records. - Can perform nursing assessments, problem identification, and care plan development. - Is adaptable to new technology – experience with computer documentation. - Has excellent time management skills. - Can assess, evaluate, and problem-solve patients’ conditions and concerns. - Possesses strong verbal and written communication skills. - Is meticulous and dedicated to providing accurate documentation. - Is dependable and focused on achieving goals. Work Location, Shift & Schedule This position is remote (please see remote requirements below). Shifox/Alopex full-time employees generally work Monday-Friday, 8:00 am-6:00 pm or according to the business hours of your clients’ practices. If working part-time, you and your supervisor will agree on a work schedule. Remote Position Requirements: - Reliable Internet – all programs used by care coordinators are internet-based - PC or Laptop capable of running multiple internet programs at once - A quiet and professional work environment suitable for speaking with patients about sensitive information and Protected Health Information (PHI). Compensation: $26 - $27 / hour Alopex is an equal-opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Transfer Center Specialist II (RN) coordinates the acceptance of patients into LifePoint Health system and facilitates patient transfer process with patients going out of LifePoint Health system to non-LifePoint health system. The Transfer Center Specialist (RN) performs initial admission screening and acceptance using approved clinical criteria to assure patient acceptance and admission are consistent with current protocols and procedures. The Transfer Center Specialist (RN) works in collaboration with multiple departments within the hospital and facilitates relationships with facilities, physicians, and nursing staff. The Transfer Center Specialist (RN) will work closely with the Bed/Capacity Coordinator to identify, trend and report barriers to patient throughput. This is a Remote, Full-Time opportunity. Salary Range: $29-34/hr. We are looking for experience RNs to perform the following duties: - Coordinates all components related to the admission/transfer or consult of emergent, urgent, and elective patients into an accepting facility from referring hospitals, clinics, urgent care clinics and physician offices with guaranteed appropriate level of care in timely manner, offering appropriate mode of transport as needed. - Systematic processing of patient acuity and expert level of clinical decision making, to facilitate the patient flow through the continuum of care utilizing electronic resources. - Ability to document and prioritize patient information to formulate an accurate picture of the patient and his/her condition for accepting physicians, nurses, or other healthcare workers. - Stays up to date with all departmental procedures, protocols, and communications to ensure adherence of appropriate process for final referral resolution. - Assign Transfer Priority Level for triage / transport of patients to prioritize bed and transportation resources. - Maintain Transfer Center data collection and provide feedback to referring facility on patient transition and outcomes. - Demonstrates Knowledge of human growth and development, assessment, range of treatment and care of patients for all ages of patients served. - Screens admissions, using approved criteria, for appropriateness of level of care orders and assignments of status and bed type. - Competent in the application of Medical Necessity criteria. - Educates nurses, physicians, and ancillary staff in level of care and admission/transfer issues/opportunities. - Through effective and professional communication, acts as a liaison between and with physicians, patient/family, hospital staff and patient care areas, outside agencies to promote efficient patient flow. - Demonstrates knowledge of regulatory requirements, EMTALA, Lifepoint Health Ethics and Compliance policies and quality initiatives. Monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as they relate to the provision of Transfer Center functions and Bed Management Services (as needed). - Tracks and trends barriers to patient flow, makes recommendations and develops action plans to improve processes and systems. - Flags call for Transfer Center leadership to review and escalate issues to facility Administrative Leadership. - Engages in departmental “team” approach to ensure all elements are communicated (both written and verbal) to facilitate patient transfer and/or throughput. - Coordinate with Bed/Capacity Coordinator for timely transfer, appropriate bed assignment and to ensure the patient’s information is accurate and viable. - Adheres to established protocol, procedure, and standard of care, escalates issues through the established Chain of Command in a timely manner. - Maintains current and accurate information in Electronic Health Care Record. - Actively participate in new employee orientation and on-going training, staff meetings, and continuous quality improvement projects. - Efficiently take all inbound calls and make necessary outbound calls to meet productivity goals set by the department. - Must be able to multitask by attentively listen and simultaneously type 38-40 wpm. - Must meet Internet speed requirements: Upload 50 or more; Download 100 or more. - Provides superior customer service with all interactions. - Must have clear understanding about the Transfer Center Key performance indicators and be a part of the Access Point Vision to reach the goals. Qualifications - Graduate of an accredited school/college and holds applicable current licensure in state of residence (RN). Associate’s/bachelor’s degree preferred. - Current licensure in State of Residence. Preferred Compact License. - Must maintain current nursing licensure by completing applications for renewal in a timely manner and by complying with all requirements for continuing education. - Three years of related clinical experience in an acute care setting (ED or Critical Care Preferred). - Ability to communicate effectively in oral, written, and electronic formats. - Must be able to multitask by attentively listening and simultaneously type more than 35 wpm. - Must meet Internet speed requirements: Upload 50 or more; Download 100 or more. Benefits - We offer an excellent total compensation package, including a competitive salary and benefits. - Some of our benefits include 401k, flexible PTO, generous Employee illness benefit (EIB), medical, dental, vision, tuition reimbursement, and an Employee Assistance Program. - We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Utilization Review Coordinator will report directly to the Senior Director of RCM. This team member will be responsible for handling: - Pre-certifications - Authorizations - Retro-authorizations - Appeals - Medical records requests - Chart auditing duties The Utilization Review Coordinator should be a subject matter expert on payor requirements and expectations. This role requires strategic planning and coordination with on-site providers and the revenue cycle department to obtain optimal utilization review outcomes. Responsibilities - Utilization Review on Behalf of the Clinics: - Prescreen referrals to project/anticipate authorizations. - Provide recommendations regarding level of care/services and treatment planning. - Conduct live reviews with payors and level of care chart reviews. - Clinically negotiate authorization outcomes with the payor. - Coordinate Peer-to-Peer (P2P) Review preparation and assist with scheduling. - Establish internal authorization or denial determinations for No Authorization Required (NAR) requests. - Establish post denial appeal response recommendations. - Obtain portal access to any utilization review portals for an efficient and scalable process. - Interdepartmental Relations and Communication: - Coordinate with the clinical team on requests with clinically weaker presentations. - Coordinate all concurrent insurance reviews with clinicians and medical team. - Provide ongoing feedback and recommendations for improvement. - Attend and participate in daily huddles/weekly rounds as the payor expert. - Communicate with relevant parties about any issues with coverage or denials. - Partner with intake, utilization review, and finance for best practices. - Timely completion of the Denial Notification process. - Accurate Data Entry: - Document deficiencies for identification on the daily reporting. - Timely documentation of authorization in KIPU/Avea. - Upload authorization letters to KIPU/Avea UR module. - Clinical Auditing: - Notify the primary therapist of any missing documentation or delinquent services. - Review medical records for quality clinical documentation and compliance. - Run daily reports to ensure that all information needed for timely review has been entered into the EMR. - Policy Compliance: - Ensuring compliance with legal, regulatory, and policy requirements. - Process Improvement: - Identifying clinical problems and proposing innovative solutions. - Additional job duties as assigned. Qualifications - Bachelor's degree in Social Work, Nursing, or any related field. - Clinical or UR experience in PHP or IOP levels of care. - 1-2 years of experience in the healthcare industry in utilization review or clinical care. - Expert understanding of patient documentation, chart auditing, and state and federal regulations. - Proficient in MS Office applications and ability to learn department and job-specific software systems. - Demonstrate organizational skills. - Demonstrate effective verbal and written communication skills. - Demonstrate analytical skills when problem-solving. - Demonstrate high attention to detail and a high degree of accuracy. Benefits - Health & Wellness: - Medical, dental, vision, HealthJoy unlimited therapy, UHC wellness program, HSA/FSA options, and pet insurance. - Time Off: - Responsible PTO covering vacation, sick leave, and select federal holidays. - 401(k): - With company match. - Professional Development: - $1,500 tuition reimbursement for ongoing education or CEUs, and opportunities for cross-licensure when applicable.

Summary Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care. Location: This is a remote position, from 8:30am to 5pm Monday through Friday. What You’ll Do: - Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. - Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. - Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. - Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). - Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. To Qualify For This Position, You'll Need The Following: - Required Education: Associate's in a job related field. - Degree Equivalency: 2 years job related work experience. - Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. - Required Skills and Abilities: Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. - Required Software and Tools: Microsoft Office. - Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as social worker from the United States and in the state of hire (in Div. 6B) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager. We Prefer That You Have The Following: - Preferred Work Experience: 7 years-healthcare program management. 4+ years of Renal/ Nephrology experience. - Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. - Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. - Subsidized health plans, dental and vision coverage - 401k retirement savings plan with company match - Life Insurance - Paid Time Off (PTO) - On-site cafeterias and fitness centers in major locations - Education Assistance - Service Recognition - National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.