LPN Assessment Nurse
CHSGa · Lewisburg, TN
Job description(tap to read)
Join us at NextStep Care - a place where you'll be valued, recognized and rewarded for the vital work you do each day. We'll surround you with a strong team and leadership that supports every aspect of your life - both inside and outside of our centers. And you'll get to practice your passion in a non-profit, mission-driven organization that's known for the highest level of care in our communities SUMMARY Responsible for serving as the Care Management Services' member liaison and representative by ensuring the goals of the program and those of individual members are met through primary care enhanced case management. A primary function of this position is to complete member assessments. ESSENTIAL DUTIES AND RESPONSIBILITIES • Observes members in their home environment gathering medical, environmental, and psychosocial data for review by the multidisciplinary team. • Accepts referrals and ensures potential members are screened in a timely manner as required by organization and governmental policies. • Addresses member or caregiver concerns effectively and efficiently. • Assist in carepath developments, recommending HCBS services and incorporating roles for informal caregivers. • Records and documents member information completely and accurately in accordance with federal, state, and operational guidelines. • Works to preserve the essential role of the family and informal caregivers in assisting embers in meeting carepath goals and addressing social risk by following up on needs identified in data gathered from members/caregivers. • Makes recommendations to multidisciplinary team that address primary care needs • In conjunction with the Care Manager for Care Management Services and the multidisciplinary team, assists in removing barriers to primary and specialized medical care, to support optimal health and functional status. • Collborates with effectively with the Quality Department in resolving items needing additional information or clarification when identified on assessment review, to ensure standards of promptness and members needs are met in a timely manner. • Advocate for informed decisions by members and caregivers regarding their health stauts and options for treatment or care. • Promotes quality outcomes through effective collaboration with the Quality Assurance and education Coordinator, Assessment Coordinator, and Administrator to ensure effective implementation of education plans, initiative, or processes. • Utilizes technology to promote workflow efficiency and to facilitate data collection, management and analysis. • Takes call on a rotating basis as assigned. • Provides on-site assistance for all state surveys. • Reports corporate compliance concerns appropriately. • Reports privacy and security concerns appropriately. • Reports work time and business expenses in accordance with organizational guidelines. • Maintains prompt, accurate and secure documentation as it relates to member needs, contacts and plans. • Maintains prompt, accurate, secure documentation as it relates to member needs, contacts and plans. • Ensures appropriate documentation is filed promptly in members' chart as outlined in Care Management. • Assists with Assessment Nurse Case Manager duties for other Care Management Services' locations as needed • Promotes the image and reputation of the System by exhibiting servant leadership and providing direct and open lines of communication. • Contributes to the work of committees, workgroups, project management, and other collaborative efforts of the System. • Performs other duties as necessary to ensure the success of the System. SKILLS AND ABILITIES • Completes work in a timely, accurate, and efficient manner. • Ability to organize and prioritize assignments/responsibilities. • Maintains constructive working relationships by communicating and interacting effectively with supervisors, organizational leadership, peers and individuals inside and outside the Organization, in a positive, professional and respectful manner • Portrays a positive image of the organization and communicates guiding principles, mission, vision and values. • Completes work in a timely, accurate, efficient and thorough manner and is conscientious about assignments/responsibilities. • Consistently reports to work on time prepared to perform duties of the position. • Manages multiple deadlines with demonstrated flexibility in working with changing priorities. • Ability to work a demanding, primarily self directed work schedule. • Demonstrates good judgment and decision making. • Exhibits exceptional organizing and planning skills. • Ability to deliver excellent customer service, externally and internally as well as maintain customer confidentiality. • Ability to react effectively and calmly in emergency situations. MINIMUM QUALIFICATIONS • Valid Georgia LPN license with 2 years of experience in the health and human services field • Experience in social work, home and community based services, healthcare or geriatrics preferred. • Valid Driver's License. • Reliable transportation. SUPERVISORY RESPONSIBILITIES None LANGUAGE SKILLS Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or associates of the organization. MATHEMATICAL SKILLS Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. REASONING ABILITY Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram format. The ability to deal with problems involving several concrete variables in standardized situations. COMPUTER APPLICATION SKILLS This job requires proficiency with the following computer applications: Microsoft Outlook Microsoft Excel Microsoft Word CERTIFICATES, LICENSES, REGISTRATIONS Please see minimum qualifications PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the associate is regularly required to sit, talk or hear. The associate frequently is required to walk. Use hands to finger, handle or feel and reach with hands and arms. The associate is occasionally required to stand. Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus. EEO / M / F / D / V / Drug Free Workplace NextStep Care Facebook
Community Health Worker, Patient Engagement
IMAGINE PEDIATRICS · Lewisburg, TN
Community Health Worker, Patient Engagement South Florida (Remote with Travel) Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. As part of the Patient Engagement Team, this role supports patients in re-engaging with Imagine Pediatrics services, ensuring they receive appropriate support by meeting them where they are. The role partners with an interdisciplinary team to address patient needs and enhance re-engagement of patients who were previously enrolled but did not complete onboarding or have not actively utilized services, ensuring they are supported in reconnecting with Imagine Pediatrics care. You will: • Serve as a community-based, patient-facing resource, building relationships with patients and caregivers through direct, in-person re-engagement in assigned geographic areas • Provide hands-on support to patients and caregivers, including assisting with program re-enrollment, onboarding, and mobile app setup and utilization • Perform telephonic outreach to caregivers of attributed patients to re-engage children in care, support seamless onboarding, and re-engage those who missed their initial onboarding visit or have not utilized services post-onboarding. • Educate patients and caregivers on Imagine Pediatric services and available community resources, ensuring they understand how to access care and support • Maintain and gather up-to-date knowledge of local community resources (e.g., social services, healthcare providers, SDOH supports) and connect families to appropriate services • Conduct community events and facility rounding to engage eligible patients, strengthen relationships, and support ongoing program participation • Partner with our Behavioral Health teams and local behavioral health providers to support safe patient discharge planning and ensure seamless connection to community-based resources and ongoing care. • Partner with caregivers, families, and facility staff to identify and address barriers to engagement, and access to care and work with leadership on ensuring workflows exist to enable access to care • Collaborate closely with the Patient Engagement Team (Outreach & Enrollment), including Outreach Specialists and Registered Nurses, to support patient re-engagement goals • Support non-clinical care coordination efforts in the community, including assisting with: • Connecting patients to primary care providers • Facilitating pharmacy access and medication-related needs • Providing basic discharge and follow-up support • Addressing social determinants of health (SDOH) needs • Removing barriers to care and service access • Support outreach efforts through outbound engagement calls, as needed, to assist with enrollment, follow-up, and achievement of patient engagement metrics First and foremost, you're passionate and committed to reimagining pediatric health care and creating a world where every child with complex medical conditions gets the care and support they deserve. You will need: • A valid driver's license • A bachelor's degree • Bilingual (Spanish) required, Medical Interpreter Certification preferred • Ability to travel frequently • 3+ years of experience in a healthcare setting (patient-facing hospital or facility role) • Ability to navigate ambiguity, think critically, take initiative, and stay organized • Ability to manage multiple tech platforms • Experience working in a patient-facing hospital or facility role • Experience working as part of an interdisciplinary team • National Community Health Worker Certification highly preferred The role offers an hourly range of $23 - $28 in addition to annual bonus incentive, competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: • Competitive medical, dental, and vision insurance • Healthcare and Dependent Care FSA; Company-funded HSA • 401(k) with 4% match, vested 100% from day one • Employer-paid short and long-term disability • Life insurance at 1x annual salary • 20 days PTO + 10 Company Holidays & 2 Floating Holidays • Paid new parent leave • Additional benefits to be detailed in offer We're guided by our five core values: • Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. • Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. • Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. • Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. • One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward — together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
Join Our Caring Community The Senior Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Compliance Professional ensures compliance with legal, contractual, statutory and regulatory requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Compliance Professional develops and implements compliance policies and procedures. Research compliance issues and recommend changes that ensure compliance with contract obligations. Maintain relationships with government agencies. Coordinate site visits for regulators, coordinates implementation and compliance with corrective action plans. Begin to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and performs work without direction. Exercise considerable latitude in determining objectives and approaches to assignments. Is accountable for accurate, timely and complete deliverables associated with contractual and regulatory requirements. Exercise due diligence in reviewing documentation and communicates complex issues clearly and logically, both verbally and in writing. Demonstrate leadership with integrity and a willingness to accept responsibility and implement process improvements whenever possible. Build relationships with internal and external partners through consistency, reliability, willingness to assist and support and sharing in a "same team" mentality. Must participate on camera for meetings and is expected to actively participate and collaborate, and where appropriate, lead calls, drive discussions, ask critical questions, and recommend strategies and solutions. Although this is a remote position, the associate in this position will be expected to work in the office no less than one day per month and as needed for training and other meetings. Use Your Skills To Make An Impact Required Qualifications • Bachelor's degree • Minimum 5 years' experience in healthcare compliance and cross functional collaboration • Knowledge of laws and regulations governed by the Department of Insurance and CMS • Audit, consolidating, compliance experience • Intermediate or Advanced MS Office Suite, (Word, Excel) • Experience applying laws, regulations, and contracts to achieve day to day business solutions. Preferred Qualifications • J.D. preferred; graduate or advanced degree • Experience with metrics and reporting • Experience communicating with state regulatory agencies Workstyle: Remote Work at Home Location: Louisville, KY or surrounding states Schedule: Monday through Friday 8-5 Eastern Travel: about 1 time monthly or as business needs Additional Information Driving Statement This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher. Work at Home Requirements To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. • Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Join Humana as a Case Manager Join Humana as a Case Manager within the Inclusa/Humana team, where you will serve members in the Wisconsin Family Care (FC) program. Reporting to the Manager of Care Coaching, you will provide comprehensive case management services to frail elders and adults with intellectual, developmental, or physical disabilities. Let's make a difference together! You will support members in Taylor County and surrounding areas. Job Description Main responsibilities: • Assess members health and safety needs to identify their strengths, interests, and preferences to develop a comprehensive Member Care Plan (MCP). • Coordinate with a Field Care Nurse to provide services that address members' health and safety needs, ensuring the team provides support in the least restrictive environment following the MCP. • Travel to members location to conduct face-to-face social assessments with members upon enrollment and at minimum, every six months, typically at the member's residence. • Travel to members home to conduct quarterly in-person visits and maintain monthly contact with members by phone. • Arrange support services for members, including those related to social integration, community resources, employment, housing, and other non-medical needs. • Ensure cost-effective service delivery. • Evaluate risk factors and provide education to members. • Maintain accurate documentation including case notes, service authorizations, and updates to the MCP. Use Your Skills to Make an Impact Required Qualifications: • A Bachelor's degree in human services or a related field is required, with at least 1 year of experience serving frail elders or adults with intellectual, developmental, or physical disabilities. Alternatively, a Bachelor's degree in another field with at least 3 years of such experience is also acceptable. • Travel up to 40% of your time to visit members. Valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. Preferred Qualifications: • Reside within 45 mins or less of the assigned coverage area • Case Management experience • Experience with electronic case note documentation • Knowledge of community health and social service agencies and additional community resources Additional Information Work Location: Medford, WI and surrounding area Travel: up to 40% Typical Workdays/Hours: Monday – Friday, 8:00 am – 4:30 pm CST Driving: You will be part of Humana's driver safety program and therefore requires you to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. Mileage reimbursement is provided for work-related travel. Eligible mileage includes: • Travel from your home to your first work location of the day. • Travel between client or assignment locations during the workday. • Travel from your final work location back to your home. TB Screening: This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Work at Home Requirements: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours: 40 Pay Range: $53,700 - $72,600 per year Description of Benefits: Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity® which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum. About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. Equal Opportunity Employer: It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Remote Customer Service Representative At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The world is a more interesting place when you can see it through someone else's eyes. Bring your empathy and compassion to a role that will bring out your best every day. UnitedHealthcare, part of the UnitedHealth Group family of businesses, can provide you with some of the best training and tools in the world to help build relationships and serve our existing and new customers. You'll take as many as 50 - 70 calls per day from customers who have questions about their health benefits. As their advocate, you'll use your personality and our tools to help them through the health care benefits available to them, including helping them enroll in a new plan. This is no small opportunity. Join us and discover how you can take your career to a new level. This is a full time position requiring 40 hours per week, Monday through Friday. Employees are expected to work the scheduled hours of 7:50 am - 4:35 pm EST during regular business operations. Based on business needs, occasional overtime may be required. We offer 16 weeks of paid training. The hours during training will be 8:00 am - 4:30 pm EST from Monday - Friday. No PTO during training. 100% attendance is required. Training will be on-camera and conducted virtually from your home. Primary Responsibilities: • Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence • Educate customers about the fundamentals and benefits of consumer-driven health care, guiding them on topics such as selecting the best benefit plan options, maximizing the value of their health plan benefits and choosing a quality care provider • Contact care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance • Assist customers in navigating myuhc.com and other UnitedHealth Group websites while encouraging and guiding them towards becoming self-sufficient in using these tools This role is equally challenging and rewarding. You'll be spending long periods of time on the phone and called on to research complex issues pertaining to the caller's health, status and potential plan options. To do this, you'll need to navigate across multiple databases which require fluency in computer navigation and toggling while confidently and compassionately engaging with the caller. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: • High School Diploma / GED OR equivalent years of experience • Must be 18 years of age OR older • 2+ years of customer service OR relevant experience with analyzing and solving issues / concerns • This position involves member calls, with an expected volume of 50 - 70 calls daily. It requires full attention to work duties. Employees in this role must ensure they have uninterrupted work time during their shifts, except for scheduled breaks and lunch periods. • Experience with Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications • Ability to work a full-time position requiring 40 hours per week and the scheduled hours of 7:50 am - 4:35 pm EST from Monday through Friday during regular business operations, occasional overtime may be required based on business needs Preferred Qualifications: • Sales OR Account management experience • Health Care / Insurance environment (familiarity with medical terminology, health plan documents, OR benefit plan design) • Social work, behavioral health, disease prevention, health promotion, and behavior change (working with vulnerable populations) Telecommuting Requirements: • Reside within the state of New York • Ability to keep all company sensitive documents secure (if applicable) • Required to have a dedicated work area established that is separated from other living areas and provides information privacy • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service (UHG requires a wired internet connection: cable, DSL or fiber internet service with Minimum speed standard of 25 Mb download/10-15 Mb upload. Wireless services such as satellite, hot spot, line of sight antenna cannot be used for telecommuting.) *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16 - $29 per hour based on full-time employment. We comply with all minimum wage laws as applicable. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.