Inpatient LPN Care Manager

Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. This role includes opportunity to receive an annual bonus target of 5% of annual eligible earnings. Actual bonus amounts are determined by length of time in role, individual performance, and organizational performance.

Interested applicants must be willing and able to work at least 4 days per week onsite in our Melbourne, FL office.

At Christian Care Ministry (CCM) we believe that Christians can, and should, share in one another’s burdens. Through the use of Medi-Share, a healthcare sharing ministry for Christians, we cultivate that belief.

Everyone at Christian Care Ministry agrees to our Statement of Faith which outlines our core beliefs. Although we aren’t perfect people, we are serving our perfect God to the best of our ability.

The Inpatient LPN Care Manager supports Medi-Share members needing inpatient and/or outpatient medical services by explaining the provisions of the member voted guidelines and connecting them to high quality care for optimal outcomes. As an Inpatient LPN Care Manager, you will manage a diverse workload with outbound and inbound calls to and from members, hospital case managers, and facilities receiving referrals for coordination of care.

You will collaborate with team members and work independently to achieve individual and organizational goals for the benefit of the Medi-Share membership. If you’re a compassionate, tech savvy, and seasoned nurse excited to apply your skills in an office setting alongside a team of dedicated professionals, get your application in today!

• Works with leadership, clinical staff, key internal departments, and external customers to ensure optimum clinical outcomes for members
• Reviews and interprets members’ medical records and compares them against proprietary and evidence based criteria to determine eligibility for bill sharing and advocacy for additional programs and interventions; determines if the medical record documentation supports the eligibility of requested and/or billed services
• Abstracts review related data/information accurately and timely in appropriate review systems by the appropriate means. Provides accurate and timely submission of all administrative and review-related documents to appropriate parties
• Performs ongoing reassessment of review process to offer opportunities for improvement and/or change
• Reviews requests for genetic testing to determine eligibility for sharing and implements appropriate reimbursement strategies
• Advocates for members using the Medi-Share program to meet their health care needs
• Performs case reviews, checks medical records, speaks with patients and care providers regarding treatment and collaborates with plan of care
• Reviews pre-notification of services and clinical information for care management intervention and medical appropriateness
• Performs clinical reviews paying close attention to the appropriateness of healthcare expenditures to include length of facility stays and outpatient therapy services
• Performs concurrent review and discharge planning for inpatients
• Provides for continuity of care
• Researches and assists the negotiations for LOA/SCAs for inpatients transitioning to different level of care
• Assures appropriate levels of care are received by patients
• Provides appropriate consultation and referral to intra- and interdepartmental resources to ensure members receive optimum services offered by organization
• Manages assigned clinical caseload meeting SLAs
• Performs administrative and clinical processes to ensure team and departmental goals are met
• Delivers accurate and comprehensible verbal and written communication to external customers while complying with organizational HIPAA requirements
• Maintains accurate and timely records of all communications and interventions
• Attends all required department and organization meetings
• Contributes to the exercise and expression of Christian Care Ministry’s Christian beliefs
• Strong organizational, prioritization, and process skills
• Advanced Excel skills; intermediate Microsoft office skills…