LVN Care Specialist-Child/Family Counseling

Job Summary:

The LVN Care Specialist is responsible for processing internal, incoming, and external referrals for Ambulatory services, procedures, and medications. The position will obtain prior authorizations, schedule patients, work inbound and outbound phone calls, and communicate with patients via online chat. The Position is responsible for assisting and collaborating in the delivery psychiatric nursing care consistent with the multidisciplinary recovery plan for a specific assigned patient group. Participates in gathering assessment data and jointly planning patient care within the scope of practice of an LVN. Provides care to meet the physical and emotional needs of the patient, carrying out the physician's orders in a manner that ensures quality and patient safety.

Major Responsibilities / Duties / Critical Tasks:

• Ensures current and standardized referral policies and workflows are followed and utilized on a regular basis.

• Works with providers to triage and prioritize referrals to assure timely access to services.

• Ensures complete demographic, insurance information, and appropriate/pertaining clinical information is sent to referred specialists.

• Contact insurance companies to ensure prior authorization l requirements are met including presenting the necessary medical information, if deemed necessary to prove the medical necessity of services.

• Reviews details and expectations about the referral with providers and patients.

• Identifies and utilizes community resources to include but not limited to assisting patient/family in completion of forms/applications required to receive needed services or as required. Receives requests for prior authorization through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored.

• Processes referrals and submit medical records to insurance carriers to expedite prior authorization processes.

• Manages correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.

• Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.

• Reviews the accuracy and completeness of the information requested and ensure that all supporting documents are present.

• Meets departmental goals for referral authorization processing, scheduling, and phone responsibilities.

• Meets individual productivity and accuracy requirements as determined by the Supervisor and/or Manager.

• Other duties as assigned.

• Possesses a unique knowledge regarding the patient population to be served.

• Assists in establishing and maintaining an environment that is therapeutic for persons with mental illness.

• Executes physician's orders for all assigned patients; administers medications and treatments and delivers population specific competent nursing care.

• Provides basic patient/family instruction and healthcare teaching, able to obtain consents.

• Respects and supports patient rights.

• Understands that duties, location of work and shift/pattern are subject to change as determined by the administration to meet the needs of the unit.

• Supports the mission and vision of the facility.

• Works with Residents and Fellows on quality improvement project

Discuss patient history, diagnoses, and needs.

• Follow healthcare system guidelines and regulations.

Accompanying Knowledge, Skills, Abilities and Competencies:

• Excellent written and verbal communication skills.

• Ability to organize information.

• Ability to manage sensitive information with absolute confidentiality.

• Proficiency in Microsoft Office programs (Outlook, Word, Excel, PowerPoint).

• Identifies opportunities to streamline workflows to better care for patients.

• Identifies learning needs of self and others; sets challenging and realistic goals and develops learning opportunities to meet goals.

• Adheres to internal controls established for the department.

• Always maintains patient privacy and confidentiality of records.

• Required to maintain competency in the patient safety functions related to their position.

Required Education / Experience:

• Minimum of 2 years' experience in administrative work in a clinical setting.

• May consider a combination of education and experience.

• Must possess and maintain a current LVN license to practice in the state of Texas.