LPN Coach

Specialty Care Management is the industry leader in dialysis cost containment and chronic kidney disease (CKD) management solutions. With 1 in 7 U.S. adults facing kidney disease (over 35 million Americans) and the average dialysis claim exceeding $500,000 per year, it’s imperative for self-funded health plans to have a reliable risk management partner to address these challenges. Specialty Care Management is that partner. Founded in 2002, we work with self-funded employers of all sizes to mitigate both the human and financial costs associated with renal dialysis and CKD claims. Our primary lines of business include Dialysis Risk Management & Repricing, Chronic Kidney Disease (CKD) Management & Clinical Coaching, and Comprehensive Data Analytics. We bring together top talent in Healthcare Administration, Clinical Case Management, and Provider/Payee Contract Law to deliver innovative and effective solutions. Moreover, our programs can be implemented off-cycle, are TPA agnostic, and SCM proudly boasts ZERO % of savings fees, implementation fees, or other ancillary fees, common across the industry. Further, we offer FREE data analytics services for enrolled plans, allowing SCM to proactively analyze risk levels within the member population and identify pre-dialysis claimants before they escalate into multimillion-dollar claims. This data-driven process in tandem with our industry-leading clinical programs allows SCM to help reverse and mitigate various pre-dialysis conditions, enhancing member health while safeguarding plan assets. To learn more about our solutions, email us at info@specialtycm.com, call (267) 544-0566, or schedule a complimentary discovery call by copying this link into your browser: https://go.specialtycm.com/meetwithus.

Type: Permanent and FLSA Exempt Pay: $55,000 - $65,000 annually, plus bonus potential Location: 100% remote with minimal travel Hours: Full-time with some evening and weekend hours Reports To: Clinical Director About Specialty Care Management Specialty Care Management (SCM) creates clinical and financial solutions that make employer health benefits more predictable, affordable, and sustainable. This is accomplished by providing industry leading claim analytics, chronic kidney disease (CKD) Management, Outpatient Dialysis Cost Containment Services and Oncology Management Services. Role Summary SCM’s clinical LPN has strong communication, planning, organizational and interpersonal skills. The ideal candidate has a passion for helping members to improve their self-care and reports directly to the RN Team Lead. The LPN will be tasked to assist in outreach and related supportive follow up work with member-patients and providers to support the work in reducing the risk of kidney disease and its progression to ESRD and dialysis. The primary responsibility of this role is to support Oncology members by facilitating access to essential resources and cancer-related social services. This role works closely with the RN team to reinforce oncology care plans, assist with coordination needs, and ensure timely follow-up.

Reporting: Responsible for amalgamation and creation of quarterly reports for each client group: tallying cost-savings testimonials KPI’s Medical Records: Receive and process incoming faxes: MD records including labs, meds, OV notes and input pertinent info into chart; file fax in member record and document in chart Oncology Coordination Support: Assist the oncology nursing team with supportive services, social needs navigation, and care coordination Monitor for changes in claims or labs indicating disease progression or toxicity concerns and escalate to RN Chart Audit and QA: Audit member charts for completeness, accuracy and assist with end of month reconciliation for invoice prep and Quarterly Reporting Manage Follow-up for graduated members for Oncology: labs and check-in call 1-2 x per year as directed by the managing RN. Refer to RN as needed. Other Duties and Functions Outreach assistance as needed with peak enrollment periods: Telephone calls with members to encourage engagement with the RN Coach: Assist in making initial outreach calls to members and scheduling with the assigned RN Explains program/intake & history via telephone/secure video chat and sets appointment with the member and assigned RN Gather pertinent medical records including laboratory data and medications Performs phone number research as needed/requested Able to develop good relationships with providers, family/support persons, and all members of the care team to provide education and support. Perform claims reviews and eligibility verification Assists with mailings for outreach/introductory Build supportive rapport with members, family/support persons, and providers to reinforce engagement Conduct eligibility and benefits checks related to oncology services Assist with mail or electronic distribution of member education resources Adhere and comply with HIPAA regulations in a remote-working environment. Active, unrestricted LPN license