Massachusetts Healthcare Jobs

Position

Licensed Practitioner Nurse

SCHEDULE:

• Full tim

• Monday – Friday

• No weekends no holidays

LOCATION :

• Springfield, MA

The Licensed Practical Nurse (LPN) functions under the supervision and guidance of the Nursing Supervisor, Physician, or Advance Practitioner and participates in the multi-disciplinary process of providing care and treatment to patients of all ages and provides clinical support and technical assistance to the professional medical and other staff. The LPN is responsible for functioning within the scope of practice dictated by the authority of the Massachusetts Board of Registration in Nursing. The LPN provides an understanding approach to patient care, responsive to patient needs, maintains confidentiality, and provides support to the patient’s primary care team regarding patients’ utilization management needs. The Clinical Utilization Reviewer -LPN is responsible for facilitating care for members who may have complex healthcare needs, facilitating medically necessary services

between the provider, the member, and HNE at the right level of care to promote optimal health. Serve as a clinical liaison between the primary care team and HNE UM staff.

Under the direction of an RN, the LPN UM collaborates with the patient, patient’s entire primary care team, and the Health New England UM team to facilitate care using clinical skills, principles of managed care, nationally recognized medical necessity criteria, and company medical policies. This is to ensure services requested align with and promote efficient and medically appropriate use of the member’s benefit to provide the best quality care.

The LPN approaches work with a can-do attitude, works collaboratively with the clinical and office staff, and looks to improve operations or resolve problems with thoughtful consideration and responsiveness to the needs of others.

Key Responsibilities:

*Under the direction of the RN ACO Manager

• Interact with treatment providers, PCPs, physicians, therapists, and facilities as needed to gather clinical information to support the plan of care.

• Monitor clinical quality concerns, make referrals appropriately, identify and escalate quality of care issues, specifically related to outlier cases, long LOS cases or complicated prior authorization requests

• Understand member insurance products and benefits, as well as all applicable regulatory guidelines.

• Refer to RN ACO Manager for more complex cases as appropriate or when question of potential denial of services is identified.

• Collaborate within a team of professionals, including clinical care managers, account representatives, member service associates, to provide providers with a high level of benefits education, and HNE’s medical policy requirements related to prior authorization requirements.

• Interact with external facility or providers as needed to gather clinical information to provide to HNE to support the medical necessity review process and plan of care.

• Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support our culturally and demographically diverse member population.

Health Care Team Relationships:

• The nurse cooperatively interacts within the health care team to support and contribute to the shared patient-centered/family focus care goals.

• Effective and efficient use of technological and human resources to achieve desired patient/family outcomes.

• Focuses on developing relationships within the practice and healthcare team.

• Seeks out information and learning opportunities to increase knowledge base.

• Cooperatively interacts within the health care team to support and contribute to the shared patient/family-focused care goals.

Communication:

• · Develops the ability to actively listen to the patient and other primary care team members involved in patients care.

• · Acknowledges what was communicated to them and demonstrates understanding and interest through verbalization and use of body language.

• · Maintains calm open honest approach.

• · Projects a positive image of BH.

• · Demonstrates belief in the value of each person even during busy times.

• · Communicates appropriate data and pertinent patient information on a timely and regular basis to the patient and provider.

Skills and Competencies:

• Ability to function as a team member and work independently.

• Ability to be flexible.

• Reliable transportation

• Ability to strictly adhere to confidentiality requirements.

• Accepts responsibility for own actions and views new assignments as an opportunity to develop skill and practice.

• Demonstrates understanding of practice operations, processes, and programs.

• Gives patients and fellow employees appropriate guidance as requested.

• Provides feedback as appropriate to team members and demonstrates professional behavior.

• Actively engages in process and/or quality improvement.

• Develops an understanding of BH Operating Principles and Service Standards.

• Other clinical duties as assigned.

Qualifications:

• · MA LPN license and completion of all annual licensure requirements

• · Excellent interpersonal, judgment and communication skills

• · Documentation skills

• · Ability to identify patient situations/problems requiring MD and/or RN follow up.

Preferred Work Experience:

• · 2 years’ experience in home care and/or 2 years’ experience in utilization management

Certifications:

• · Basic Life Support – American Heart Association

• · Licensed Practical Nurse – National Council of State Boards of Nursing

We strive to be the place where we can help you build the career you deserve – apply today – YOU belong at Baystate!

OUR COMPENSATION PHILOSOPHY

We offer competitive total compensation that includes pay, benefits, and other recognition programs for our employees. The base pay range shown above considers the wide range of factors that are considered in making compensation decisions including knowledge/skills; relevant experience and training; education/certifications/licensure; and other business and organizational factors. This base pay range does not include our comprehensive benefits package and any incentive payments that may be applicable to this role.

You Belong At Baystate

At Baystate Health we know that treating one another with dignity and equity is what elevates respect for our patients and staff. It makes us not just an organization, but also a community where you belong. It is how we advance the care and enhance the lives of all people.

DIVERSE TEAMS. DIVERSE PATIENTS. DIVERSE LOCATIONS.

Education:

Non-Graduate

Certifications:

Basic Life Support - Other, Licensed Practical Nurse - Other

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

Ab out Baystate Health

Baystate Health (BH) is one of New England’s leading and largest integrated health care organizations, serving a population of nearly one million people throughout western New England. With roots dating back to the founding of Springfield City Hospital in 1873, Baystate Health has been providing high-quality and compassionate health care in western Massachusetts for more than 145 years. With more than 12,000 employees, a medical staff of nearly 3,100 physicians, and a net patient service revenue of more than $1.4 billion, the ever-growing health system includes five Massachusetts hospitals and the Baystate Mary Lane Outpatient Center in Ware:

• Baystate Medical Center in Springfield

• Baystate Children’s Hospital (located at Baystate Medical Center)

• Baystate Franklin Medical Center in Greenfield

• Baystate Wing Hospital in Palmer

• Baystate Noble Hospital in Westfield