OVERALL JOB PURPOSE

Help the clinical treatment team which includes patients, patients’ care givers, treating providers and other entities as needed. 

Comprehensively assesses patients for care opportunities and collaborates with treating Physician, and Registered Nurse to develop care plans that meet patients’ needs as well as improve quality of care through the most cost effective mechanisms. 

Provides condition specific patient education and anticipatory guidance as well as care coordination under the guidance of the Physician and/or Registered Nurse. 

The goal of all activities is to improve patients’ health through use of effective quality care which will result in less use of targeted services.

The objectives are to reduce acute admissions, urgent care and emergency room utilization by 20% as well as increase the utilization of appropriate health care services such as Primary Care Physicians and appropriate specialists. 

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES

Assists in providing patient services within the ambulatory care setting. 

Maintains clinical documentation within the medical records assuring compliance within all guidelines. 

Participates in health promotion activities and Summit Quality Management Program. 

Assists the PCP and Case Manager in the monitoring and planning of care in the low acuity members of the High Risk Program and/or Disease Management Programs. 

Maintains an active nursing appointment schedule for assisting the PCP in the monitoring of members’ health care needs. This may include but is not limited to B/P checks, wound care needs, nebulizer treatments, and health care education. 

Assists the Case Manager & PCP in the follow-up management of post-hospitalized or post-emergency room visits. This may include but is not limited to Hospital/ER follow-up phone calls, requesting hospital medical records, etc. 

Assist the RN Care Coordinator on basic responsibilities in order to fill in as needed. 

Responsible for working with the office RN in developing comprehensive patient assessments through health care records, physician and patient interviews.

Helps develop and implement comprehensive patient care plans.

Collaborates with medical personnel caring for members.

Responsible for making recommendations to medical personnel regarding effectiveness of health care resources.

Research and recommend alternative services as needed. 

Utilizes community resources as appropriate.

Coordinates members’ plan benefits with health plan.

Coordinate clinical team efforts with patients, primary care physicians, families and other providers.

Responsible for quality and continuous improvement within the job scope.

Responsible for the goals outlined in the job description. 

Responsible for all actions/responsibilities as described in company controlled documentation for this position.

Participates in team meetings.

Participates in developing and providing input in the processes of the care coordination program. 

Follows Medical Services Department policies and procedures for reporting and following patients.

OTHER JOB DUTIES AND RESPONSIBILITIES

Performs others duties and responsibilities as assigned.

Willing to work overtime, as needed.

Meet with external group(s) as needed.

Minimal travel as necessary.

WORKING CONDITIONS 

Normal working conditions.

Categories I Task (identifies the risk level as indicated under OSHA) are those that expose a worker to blood, body fluids, or tissues or those that have a chance of spills or splashes. These tasks always require specific protective measures.

PHYSICAL REQUIREMENTS

Frequent lifting and carrying items weight up to 30 pounds unassisted, including assisting patients when required.

Adequate physical ability including sufficient manual dexterity to perform the requisite health care service, including injections.

Frequent bending, reaching, repetitive hand movements, standing, walking, squatting, and sitting, with some heavy lifting, pushing and pulling exerted regularly throughout a regular work shift. 

SUMMARY

This job description reflects the general duties and is not intended, and should not be construed to be, an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended, however to be an accurate reflection of those principal job elements essential for making decisions related to job performance, employee development and compensation. As such, the incumbent may perform other duties and responsibilities as required.

We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.

LPN licensed in the state of Texas. 

Five years in a professional setting such as hospital or clinic setting. 

CPR certified or able to obtain in 60 days of employment.