LICENSE VOCATIONAL NURSE-LCM

BLEHEALTH, LLC - The Lead Care Manager (LVN) works in collaboration and continuous partnership with chronically ill or “high-risk” members and their family/caregiver(s), clinic/hospital/specialty providers and staff, and community resources in a team approach to: • Coordinate with those individuals and/or entities to ensure a seamless experience for the member and non-duplication of services • Engage eligible members • Oversee provision of ECM services and implementation of the care plan. • Offer services where the member lives, seeks care, or finds most easily accessible and within the Plan guidelines • Connect member to other social services and supports the member may need, including transportation • Advocate on behalf of members with health care professionals • Use motivational interviewing, trauma-informed care, and harm-reduction approaches • Coordinate with hospital staff on discharge plans • Accompany member to office visits, as needed and according to the Plan guidelines • Monitor treatment adherence (including medication) • Provide health promotion and self-management training • Promote timely access to appropriate care • Increase utilization of preventative care • Reduce emergency room utilization and hospital readmissions • Increase comprehension through culturally and linguistically appropriate education • Create and promote adherence to a care plan, developed in coordination with the member, primary care provider, and family/caregiver(s) • Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals • Increase members’ ability for self-management and shared decision-making • Connecting members to relevant community resources to enhance member health and well-being, increase member satisfaction, and reduce health care costs • Connect and follow up with members, family/caregiver(s), providers, and community resources via face-to-face, secure email, phone calls, text messages, and other communications • Serve as the contact point, advocate, and informational resource for members, care team, family/caregiver(s), payers, and community resources • Work with members to plan and monitor care • Assess member’s unmet health and social needs • Develop a care plan with the member, family/caregiver(s), and providers (emergency plan, health management plan, medical summary, and ongoing action plan, as appropriate) • Monitor adherence to care plans, evaluate effectiveness, monitor member progress on time, and facilitate changes as needed • Create ongoing processes for members and family/caregiver(s) to determine and request the level of care coordination support they desire at any given time • Facilitate member access to appropriate medical and specialty providers • Educate members and family/caregiver(s) about relevant community resources • Facilitate and attend meetings between members, family/caregiver(s), care team, payers, and community resources, as needed • Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals • Assist with the identification of “high-risk” members (the chronically ill and those with special health care needs), and add these to the member registry (or flag in EHR) • Attend all Lead Care Manager training courses/webinars and meetings • Provide feedback for the improvement of the ECM Program • Offer services where the Member lives, seeks care, or finds most easily accessible and within Medi-Cal Managed Care health plans (MCP) guidelines • Engage eligible Members • Arrange transportation • Call Member to facilitate Member visit with the ECM Lead Care Manager QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below represent the required knowledge, skill, and/or ability. Reasonable accommodations may enable individuals with disabilities to perform essential functions. • Although this role is remote, there will be times when you will be required to report to our satellite office (or a specified, remote location) to work, to attend meetings, or other training • Required to have and maintain your own personal vehicle for this role You will receive a monthly mileage reimbursement per applicable state/federal laws • You must have a valid driver’s license, proof of insurance, and a good driving record • You will visit hospitals and visit patients at their homes, as needed • Must present proof of Negative TB Test & CPR Certification before hire date • Must complete a Live Scan Fingerprint/Background check EDUCATION AND/OR EXPERIENCE: • An associate’s degree, or bachelor's degree in health science or any related health care degree is preferred • Social Worker, LVN, or experience in case management is a PLUS! SKILL AND KNOWLEDGE REQUIREMENTS: • Excellent analytical, problem-solving, and prioritization skills • Excellent verbal and written communication skills • High-level of interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams that may include employees, customers, and physicians • Effective computer skills, particularly Microsoft Office, Excel, PowerPoint, Word, etc. • Work independently to complete assigned tasks • Team building • Project Management • Change Management • Quality and Process improvement tools • Project Execution • MUST consistently achieve a minimum daily expectation of 30 schedules/day BENEFITS: • Medical/Dental/Vision - available after successful completion of the 90-day probationary period • Free $100K Life Insurance • 401k eligibility after 1,000 hours of service • Starting hourly range for this role is $30-$32 per hour