UM Specialist; LVN - SNF - Sharp Extended Care

Hours

Shift Start Time: 8 AM

Shift End Time: 4:30 PM

AWS Hours Requirement: 8/40 - 8 Hour Shift

Additional Shift Information: 8 hour shifts

Weekend Requirements: No Weekends

On-Call

Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum): $36.830 - $47.530 - $53.230

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

As part of our recruitment process, you may receive communication from Dawn, our virtual recruiting assistant. Dawn helps coordinate scheduling for screening calls and interviews to ensure a smooth and timely experience. Rest assured, all candidate evaluations and hiring decisions are made by our recruitment and hiring teams.

To provide comprehensive utilization management and coordination of care for members who are confined to skilled nursing facilities (SNF) in collaboration with designated SNF physician or Sharp Community Medical Group primary care physician, as appropriate to ensure cost effective quality service throughout the continuum of care.

• Graduate of an accredited Licensed Vocational Nurse (LVN) program
• 3 Years experience in the acute patient care and/or SNF setting
• California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians
  -REQUIRED

• Experience as a case manager or discharge planner interacting with managed care payers.

• Act as a resource. Facilitates direct admissions to SNF from the Emergency Room, Physician offices, or home coordinating with the SNF admission liaison for authorization of level of care as appropriate. Assists with transfers to SNF of Medical Group members from Out of Network (OON) and /or Out of Area (OOA).
• Census and rounds. Reviews and updates SNF daily census log, adds new patients and makes corrections when needed reconciling patients/facility location, HP information and SNF benefits. Reviews every patient under assigned workload one business day and assigns an LOS based on MCG, prior level of function, comorbidities, and discharge goals. Rounds and/or reviews with the Sharp Extended Care (SEC) provider on site and/or telephonically.
  
  Keeps SEC Nurse Supervisor or SEC provider of any adverse development, delay in discharge or services, readmissions to acute or visit to the ER. Attends and participates in SNF rounds, and/or patient care conferences as appropriate. Attends clinical in-services or required operational/clinical training sessions. Informs quality department of any quality issues.
• Chart review. Performs a comprehensive review of medical history, doctor’s orders, progress notes, therapy notes, vital signs sheet, laboratory results, discharge planning notes and other pertinent medical information to determine whether patient is meeting skilled care criteria based on MCG Recovery Care Guidelines and Health plan SNF guidelines. Performs data entry related to patient management activities using the IDX computer system per departmental guidelines.
  
  Complies with contracted health plan requirements for documentation of concurrent SNF review and utilization management activities performed in a manner consistent with Medical Groups’ policies and procedures. Assists in obtaining medical information necessary for activities related to Medical Groups’ Quality and Appeals processes.
• Demonstrates knowledge of department policies and procedures. Authorizes appropriate care levels, i.e. sub-acute, short term SNF or custodial, as well as services and supplies through patient’s medical group (or health plan, as applicable). Provides authorization as needed for DME or other services for post skilled nursing facility placement or home care. Ensures compliance with all applicable regulatory and health plan guidelines for issuance of notice letters (e.g., Medicare notice of non-coverage,…