Case Manager-LVN

Loma Linda • Redlands, CA

103d

About The Position

The Case Manager-LVN is responsible for case management of the patient/family across the health care continuum, to include those with complex medical, socio-economic, and mental health co-morbidities. Case Manager-LVN is responsible for utilization management, disease management, complex case management and inpatient care management in a telephonic and/or onsite care management position. Reviews inpatient and outpatient services to determine medical appropriateness following evaluation of medical guidelines and benefit determination. This role acts as a support to team members, coaching and providing feedback as necessary. The LVN-Case Manager will act as a patient/family advocate guiding them through the Health Care system for transition planning. The LVN-Case Manager will participate in on-call rotation after-hours and/or on weekends as needed to meet contractual obligations and provide decision support on managed care issues. Performs other duties as needed.

Requirements

• Bachelor's Degree preferred.
• Graduate of a school of Licensed Vocational Nursing (LVN) required.
• Minimum five years experience in managed care required.
• Minimum two years ambulatory care management program and/or case management experience required.
• Experience may be considered in lieu of Degree.

Nice To Haves

• Bilingual preferred.
• Knowledge of lines of business (LOB) including Commercial, United Health Care, Anthem Blue Cross, Blue Shield of California, Medicare Advantage, ACO.
• Proficient in application of MCG for both inpatient and ambulatory care.

Responsibilities

• Manage case management of patients/families across the health care continuum.
• Handle utilization management, disease management, complex case management, and inpatient care management.
• Review inpatient and outpatient services for medical appropriateness.
• Support team members through coaching and feedback.
• Act as a patient/family advocate for transition planning.
• Participate in on-call rotation after-hours and/or on weekends.
• Provide decision support on managed care issues.
• Perform other duties as needed.

Benefits

• Active California Licensed Vocational Nurse (LVN) required.
• Basic Life Support (BLS) certification from the American Heart Association (AHA) required.
• Certified Managed Care Nurses from the American Association of Managed Care Nurses within two years of hire.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees