iCMP PLUS LPN

Why This Role is Important to Us Commonwealth Care Alliance’s (CCA) iCMP Plus ACO inter-professional teams are responsible for providing primary care and care management to a specific panel of high risk, Medicaid ACO eligible, non CCA patients.

This patient group is made up of individuals with significant medical, behavioral, and social complexities that require intensive case management.

This cohort of patients belong to outside organizations that are contracted with CCA to provide this complex care.

The iCMP Plus Licensed Practical Nurse (LPN) functions within and is an integral part of an inter-professional team.

This team is responsible for the care coordination and care delivery of a panel of Medicaid ACO patients.

The LPN will be responsible for evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of Mass General Brigham’s Mass Health benefits plan.

The LPN is responsible for the provision of Durable Medical Equipment (DME) through completion of necessary paperwork (in coordination with the assigned Advanced Practice Clinician), submission of requests to Mass Health and identified vendors and confirmation of receipt by the patient.

The LPN is additionally responsible for the provision of PCA services and HHA services for the iCMP PLUS patient panel as appropriate and necessary.

This role also includes providing input to members’ care teams on key care management/care coordination decisions, including the adjustment of the member centered care plan and identification of the need for durable medical equipment and services.

Finally, this position may require in-person visits to patients in their homes and will support patients across the iCMP PLUS Program.

* Knowledge and experience with DME/medical supplies and Medicare/MassHealth guidelines strongly preferred.* Experience with disability issues preferred.* Proven skills and judgment necessary for independent decision making.* Strong organizational, time management and problem-solving skills.* Ability to function effectively within a multi-disciplinary team.* Effective oral and written skills.

Strong interpersonal and customer relations skills.* Comfort working with DME vendors, verifying accuracy of products and quotes.* Demonstrated proficiency with Microsoft Excel, Word and Outlook The iCMP PLUS LPN will report to the Director of Clinical Operations and Client Programs and a dotted line to the iCMP Plus Clinical Manager.

What We’re Looking For * Minimum Education Required
– High School Diploma, GED or equivalent experience * Preferred Education
– Associate’s Degree * Minimum Years’ Experience Required: High School Diploma with 2 years’ experience in community-based care* Must hold current LPN to practice in Massachusetts * Preferred Years’ Experience: Associates Degree with 3+ years of minimum experience working in outreach or in the community with members who have high behavioral health needs and high medical complexity.* Preferred Training and Certification(s):Current CPR Certification * Excellent written and verbal communication skills.* Working knowledge of Microsoft Office applications* Excellent organizational skills.* Ability to utilize an Electronic Medical Record* Ability to use on-line training platforms* Demonstrated understanding of Mass health benefits* Ability to review welcome packets and obtain consent forms* Demonstrated understanding of LTSS English required bilingual preferred Actual Work Location 10 Northampton Street, Boston, Massachusetts 02119 All Locations Northampton 10; 30 Northampton Exempt / Not Exempt Exempt What You’ll Be Doing * Conducts decision review for services requiring prior authorization in DME, leveraging technology, guidelines and resources as available.* Processes orders for supplies, equipment and nutritional supplements based on referrals from the interdisciplinary team and submits referrals for authorization by MassHealth; leverages preferred providers and clearly notes rationale for use of non-preferred providers if/when used.* Serves as subject matter expert in DME within CCA’s iCMP PLUS Program.* Assures proper, accurate and timely documentation in the medical record.* Works closely with the interdisciplinary team and escalations with the Director of Clinical Operations and Client Programs as well as Clinical Management to determine next steps for DME requests, including denials following identified Standard Operating Procedures (SOP).* Communicates status of DME, HHA and PCA services and orders in the medical record to facilitate communication between the interdisciplinary team and LPN* Assesses need for additional structured clinical data for completion of service request.* Handles all requests timely and accurately, adhering to performance and operational measures.* Follows department and organizational policies and procedures as well as adheres to all applicable regulatory, contractual and compliance requirements.* Performs all activities with closed loop processes.* Conducts follow-up telephone calls with patients to ensure satisfaction with equipment purchases/modification and track on spreadsheet.

Bring concerns to supervisor as necessary* Maintains appropriate written and oral communication on a timely basis, completing documentation within 48 hours and returning non-urgent calls within 48 hours.* Identify gaps in care, barriers to care and unmet patient needs.* Coordinate with the Care Partner along with the PCP and iCMP Plus inter-professional care team to identify areas of opportunity, as well as defined resources.* Provide input to patients care team on key care management/care coordination decisions.* Support efforts to decrease hospital readmissions and high emergency department use.* Participate in weekly Interprofessional Care Team meetings.* Ensures appropriate documentation of all activities within EPIC system* Provides consultation and support to other members of the iCMP Plus Care Team.* Other related duties may be assigned.* Actively participates in the evaluation of own performance and progress* Participates in on-going education and training to improve skills* Assists management with the development, refinement and enhancement of clinical programs, initiatives, processes, policies, workflows, and projects.* Participates in committees and workgroups that promote clinical excellence.