Case Manager LVN-LPN

HumanGood•Los Altos, CA

5d•Onsite

About The Position

Make an impact beyond the bedside by helping residents successfully transition from skilled nursing to their next level of care. As a Case Manager – LVN/LPN, you’ll coordinate care and discharge planning for skilled nursing and post-acute residents, partnering with residents, families, clinical teams, physicians, payers, and community providers to support safe and timely transitions. This role is ideal for an LVN/LPN who enjoys care coordination, problem-solving, resident and family communication, and interdisciplinary teamwork.

Requirements

Current, active LVN or LPN license in the state of employment and graduation from an accredited nursing program.
At least 2 years of licensed nursing experience in skilled nursing, post-acute care, rehabilitation, discharge planning, case management, or a related clinical setting.
Experience with interdisciplinary care planning, discharge planning, care transitions, or post-acute service coordination.
Strong communication, organization, documentation, and problem-solving skills.
Current CPR/BLS certification and proficiency with electronic health records, as required.

Nice To Haves

3+ years of skilled nursing or post-acute nursing experience.
Experience with Short Stay care coordination, PDPM, Medicare/Medicare Advantage, payer authorizations, or ACOs.
Experience coordinating home health, DME, rehabilitation, transportation, appointments, and other discharge services.
Familiarity with PointClickCare, readmission-reduction initiatives, quality improvement, or care-transition programs.

Responsibilities

Manage a caseload of skilled nursing and post-acute residents from admission through discharge.
Develop and coordinate discharge plans, identifying resident goals, caregiver support, potential barriers, and post-discharge needs.
Partner with residents, families, nursing, rehabilitation, social services, physicians, payers, and outside providers to coordinate care and transitions.
Coordinate follow-up services including home health, rehabilitation, medical equipment, medications, transportation, appointments, and community resources.
Educate residents and families on discharge plans, follow-up care, medications, treatments, and available resources.
Monitor resident progress, participate in interdisciplinary care planning, and escalate clinical concerns or changes in condition as appropriate.
Maintain accurate and timely case-management, care-planning, and discharge documentation.
Support post-discharge follow-up, payer requirements, quality initiatives, and efforts to reduce avoidable readmissions.