POSITION SUMMARY:
The Licensed Practical Nurse Navigator is responsible for performing and coordinating clinical and administrative functions within their assigned clinical services program (DSNP, ASO, CDM, Perinatal Program) alongside of the Registered Nurse Navigator, Social Worker or Health Coach. Their responsibilities may include but are not limited to: direct member and provider interactions related to performing health risk and other assessments, health maintenance and disease specific intervention activities, carrying out care plan interventions, adjusting and modifying care plans, scheduling Interdisciplinary Care Team (ICT) meetings/planning care team agendas/taking care team minutes, coordinating program referrals across internal teams and external community based organizations, gathering/generating and electronic filing of clinical records and reports, conducting clinical mailings and assisting with unit phone coverage for clinical interactions as an integral part of the ICT.
QUALIFICATIONS REQUIRED: (Education, Experience, Skills)
1. Must have an active LPN license in either Ohio or West Virginia prior to beginning employment at THP. All LPNs are expected to minimally hold licenses in both Ohio and West Virginia by the end of the 90 day probationary period. Additional licenses may be needed per LOB.
2. A minimum of 2 years of LPN experience in a clinical setting
3. Demonstration of strong medical/behavioral knowledge base to support working with members and providers
4. Computer literacy; must be able to demonstrate appropriate word processing/keyboarding/personal computer use skills to navigate the clinical services electronic medical record, utilization management and HEART platforms
5. Demonstration of excellent verbal, grammar and writing skills to communicate effectively with members, providers and the ICT
QUALIFICATIONS DESIRED: (Education, Experience, Skills)
1. Motivation and initiative, should demonstrate the ability to work independently on assigned projects but also function as a cohesive team member
2. Excellent time management skills, should display the ability to prioritize tasks and complete projects timely to comply with regulatory time frames.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:
1. Performs outbound calls to members and providers
2. Participates in assessment of members utilizing THP scripts and assessments
3. Maintains documentation to support care coordination within the electronic medical record to support all member and provider interactions
4. Performs any/all care plan interventions within the scope of practice
5. Educates members regarding health and wellness, disease management tools/practices and medication adherence within the scope of their practice
6. Refers to needed health services internally and externally and facilitates access to, or arranges community resources as appropriate
7. Coordinates ICT activities and services as the primary documenter for ICT team functions
8. Facilitates collection and coordination of documents within the electronic medical record to support care coordination functions across the ICT
9. Performs member mailings to support health maintenance activities and receives return mail from members and providers for entry into the electronic medical record
10. Maintains adequate productivity as compared to peers on a monthly basis
11. Maintains monthly quality interrater scores at or above 90% utilizing the THP LPN Navigator monitoring tool
12. Acts as a resource to others within and across departments, participates in training/mentoring other employees when required
13. Displays an understanding of benefits, services and networks to support member access to care and directs members to appropriate internal and external resources to support all needs
14. Understand and complies with regulatory requirements including timeframes and documentation standards. Helps member actively and knowledgably participate with their provider in their own health care decision-making.
Equal Opportunity Employer
The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.
