LVN Clinical Intake Coordinator

KHS reasonably expects to pay starting compensation for the position of LVN Clinical Intake Coordinator in the range of $30.20 – $40.05 hourly.   Our Mission.. Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system. PRIMARY PURPOSE: Under the direction of the Kern Health Systems Director of Utilization Management (UM) RN, UM Clinical Manager RN and/or the UM Clinical Supervisor RN, the LVN Clinical Intake Coordinator is responsible for supporting the clinical Utilization Management activities for KHS members.  CLASS CHARACTERISTICS: Under the direct supervision of the UM Clinical Supervisor RN, the LVN Clinical Intake Coordinator screens prospective, concurrent, and retrospective referrals for medical necessity using Medi-Cal criteria, evidenced based criteria, and KHS policy and procedure.  Should the screening result in any mismatch of clinical data when compared with the accepted medical necessity screening tools, the LVN Clinical Intake Coordinator will refer the request to the KHS Medical Director for assessment and determination.  The LVN Clinical Intake Coordinator will work in partnership with the UM Clinical Supervisor RN to provide clarification on criteria, interpretation of benefits, and whenever needing additional clinical expertise and/or guidance.   SUPERVISES:      None   MAJOR DUTIES & RESPONSIBILITIES: Data collection and screening of prospective, concurrent, and retrospective referrals and authorizations for medical necessity and appropriateness of services and care using evidenced based guidelines. Appropriately refers cases that do not meet medical necessity to the Medical Director for evaluation. Works collaboratively with the UM team to ensure regulatory turnaround timeframes are met. Assists in the authorization and processing of automatic referral requests. Responsible for written and verbal communication with contract providers and internal KHS staff to promote timely coordination of care and dissemination of KHS policies and procedures. Collaborates with other KHS departments. Identifies and refers quality of care, coordination of benefits, and third-party liability issues as appropriate. Maintains knowledge of covered benefits for all programs. Identifies and refers cases appropriate for Case Management evaluation. Identifies authorization issues and brings those requiring attention to the UM Supervisor or RN Clinical Intake Coordinator. Under the direct supervision of the RN Clinical Supervisor, reviews requests for non-par services and coordinates these with input from the Medical Director based on par provider availability in the member’s geographic area. Maintains and updates authorizations in the core claims system to enable timely payment of claims. Keeps current with California Children’s Services benefits and guidelines for coordination of services.  REQUIREMENTS: CORE COMPENTENCIES / KNOWLEDGE & SKILL REQUIREMENTS   Lead by example to support a positive work environment that values patient advocacy, respectful listening, diverse expression of opinion and constructive conflict resolution. Adheres to KHS’s Code of Ethics and Business Conduct and all company policies, e.g., confidentiality, attendance, safety/security, use of equipment and technology, appearance, and demeanor. Represent KHS in a positive manner to all members, caregivers, staff, and external stakeholders.  Demonstrate commitment to continuous improvement. Strong knowledge of acute chronic care nursing principles, methods, and common treatments. Strong knowledge of common human diseases and usual and customary methods of treatments. Demonstrated knowledge of medical terminology. Ability to effectively evaluate medical records to determine appropriateness and necessity of care. Demonstrated knowledge of health care delivery systems. Very strong interpersonal skills, including the ability to establish and maintain effective working relationships with individual at all levels both inside and outside of KHS. Ability to use tact and diplomacy to diffuse emotional situations. Effective oral and written communication skills, including the ability to effectively explain complex information and document according to standards. Intermediate skills in Word and Excel with basic ability to enter data into and navigate through a database. Demonstrated ability to respect and maintain the confidentiality of all sensitive documents, records, discussions, and other information generated in connection with activities conducted in, or related to, patient healthcare, KHS business or employee information and make no disclosure of such information except as required in the conduct of business. Demonstrated ability to commit to and facilitate an atmosphere of collaboration and teamwork. Self-directed, with proven ability to work independently with minimum supervision. Demonstrated ability to multi-task in an interrupt-driven environment and complete assignments on a timely basis. Strong attention to detail; work accurately and at a reasonable rate of speed.  Department productivity standard is an average of 5 cases processed per hour. Compliant with KHS policies and procedures; performs the job safely and with respect to others, to property, and to individual safety.    EDUCATION, EXPERIENCE & TRAINING REQUIRED: Current, valid, unrestricted, Licensed Vocational Nurse (LVN) license in California. 2 years of full-time clinical experience  Experience working in case management utilization review, or discharge planning preferred. Working knowledge of Medi-Cal/ Medicare guidelines preferred. Experience in an HMO/ Managed Care setting is preferred.   OTHER REQUIREMENTS: Valid California Driver License

Salary : $30 - $40