Managed Care Provider Relations Manager jobs in Gulfport, MS

Job Summary:

Under the direction of the Value Based Coordinator, the LPN - Managed Care, role is to provide clinical expertise for specific complex and/or rising risk patient populations with a design to meet specific contractual and program related requirements. Ensures excellence with transitions of care to achieve optimal clinical outcomes through a seamless model of access and care. Focuses on improving the health status and care for individuals with chronic conditions with complex medical, mental health and psychosocial issues. The LPN - Managed Care demonstrates knowledge and skills to appropriately communicate and interact with staff, patients, families and visitors of all age groups while being sensitive to their cultural and religious beliefs.

Job Responsibilities:

• Act as liaison between healthcare providers, nurse facilities, hospitals, patients and insurance companies to ensure consistent and cost-effective care
• Evaluate patient's plan of care and make recommendations about care alternatives that will aid in the quality of care for patients while keeping costs low
• Educate patients and caregivers about preventative healthcare, such as regular doctor's visits and vaccinations, as well as disease management
• Thoroughly and accurately ensure compliance with ACO and insurances requirements/specifications for annual wellness visits
• Identify members with chronic conditions and / or gaps in care that can be positively impacted, as it relates to quality and care costs
• Collaborate with the appropriate individuals to offer ideas and solutions to refine and improve existing practices that will enhance patient outcomes
• Distribute educational information to patients and educate patients on preventive measures
• Ensure that proactive measures for wellness visits are achieved
• Ensure follow up so that patients attend needed appointments to address gaps in care
• Ensure that all needed measures are ordered and appropriately addressed by providers at each visit
• Identify gap opportunities for all visits not just wellness visits
• Closely assess a patient's emotional, physical, and psychological state in order to ensure they receive timely interventions and quality care
• Encourage regular doctor visits and staying up to date on vaccinations to help patients maintain their health and to reduce medical costs
• Assess the care plans of patients and make recommendations to ensure efficacy and cost-effectiveness

Job Requirements:

• Graduate of an accredited school of nursing
• Current Mississippi Board of Nursing License
• Current CPR Basic Life Support (BLS) through American Heart Association
• Demonstrate knowledge and skills in the administration of their duties in addition to performing phlebotomy
• Basic knowledge of clinical operations
• Demonstrates skills in written and oral communication
• Ability to comprehend and perform duties with minimal supervision
• Ability to prioritize work and accept constructive criticism
• Ability to prepare reports and follow-up as necessary
• Must continuously listen, visualize and have dexterity and eye-hand coordination
• Must have full range of body motion
• Must frequently sit, reach, use both right and left forearm rotation, walk, stand, kneel and twist

Physical and Other Requirements:

• Continuously listen, visualize, and have dexterity and eye-hand coordination
• Frequently sit, squat, reach, use both right and left forearm rotation, walk and stand
• Occasionally kneel, twist, have ability to grasp firmly, lift and carry, push and pull in excess of 10 lbs.