LVN- HH/DME

  Job Description

 

Responsible for coordination of Home Healthcare services to members that meet Medicare Guidelines for Home Healthcare (HHC) and Durable Medical Equipment (DME) while addressing individual needs of the member, their benefit plan, and community resources.  Responsible for the processing and data entry of health services information per regulatory guidelines and company policy.

 Responsibilities and Functions

 

1.  Interfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning, and alternative treatment plan development.

 

2.  Initiates contact with members, physicians, providers and vendors to coordinate care and/or discuss the alternative treatment plan.

 

3.  Reviews and evaluates clinical documentation prior to authorization and reauthorization of additional services, to ensure that requested services are appropriate.

 

4.  Data entry of HHC and DEM requests per established guidelines.

 

5.  Collaborates with the Home Health/DME Case Manager to achieve identified patient outcomes.

 

6.  Coordinates the treatment plan to accommodate the health service needs of the patient, benefit availability, and community resources.

7.  Refers cases to the generalist case managers, if additional case management follow up or intervention is required, outside of HHC and DME needs.

 

8.  Identifies high-risk/high-cost patients for possible case management intervention.

 

9.  Communicates denial decisions to all appropriate parties following established guidelines.

 

10.  Identifies cases with potential quality of care issue and appropriately refers cases with questionable quality of care to the Home Health/DME Case Manager or Manager of Quality Assurance in writing.

 



 

Minimum Requirements

 

Education: Current Licensure as a Licensed Vocational nurse in the state of Texas

 

Experience:  Three (3) years recent experience in a home health/DME environment.

1-2 years experience in a managed care environment.

 

Job Related Skills:

?  Verbal and written communication skills

?  Interpersonal skills

?  Organizational skills

?  Typing or basic computer knowledge

?  Knowledge of Medicare Home Healthcare and Durable Medical Equipment guidelines

?  Knowledge of current health care practices and appropriate treatments

?  Knowledge of community resources

 

 

HealthSpring offers a competitive salary and a full range of benefits.

 

Go to www.texsashealthspring.com & complete an online application.

 

Select Department:  Health Services

Select Position: LVN  HH/DME

 

 

Attach resume. Include salary history/requirement. No phone calls accepted.

HealthSpring, Inc. is an EEO/AA employer.