Health Plan Case Manager LVN
About The Position
Reporting to the Director CVHP Operations, CVHP Operations, this position coordinates care and service for defined patient populations across the acute care continuum for CVHP members. This includes discharge planning, utilization management, care coordination, and support for resource utilization. This position works collaboratively with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources. The incumbent makes significant contributions toward achievement of desired clinical, financial, and resource utilization outcomes.
Requirements
- High school diploma or equivalent is required.
- Current licensure as a Registered Nurse in the state of California is required.
- Current American Heart Association (AHA) Healthcare Provider CPR card is required.
- Excellent communication skills, critical thinking, creative problem-solving skills, and competent organizational and planning skills are required.
- Ability to be self-directed and tolerate frequent interruptions while managing a demanding workload is required.
Nice To Haves
- A degree from an accredited baccalaureate nursing program is preferred.
- CCM national certification is preferred.
- Experience with two (2) areas of clinical specialty is preferred.
- Knowledge regarding hospital protocol and procedures, clinical standards and outcomes, funding options, familiarity with community resources and outside professional agencies, familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial structure of health plan and delivery system is preferred.
Responsibilities
- Coordinates care and service for defined patient populations across the acute care continuum for CVHP members.
- Manages discharge planning, utilization management, and care coordination.
- Supports resource utilization.
- Works collaboratively with an interdisciplinary team to improve patient care through effective utilization of facility resources.
- Makes significant contributions toward achievement of desired clinical, financial, and resource utilization outcomes.
Benefits
- Equal Opportunity Employer status
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
