LICENSE VOCATIONAL NURSE-LCM (Los Angeles-Inglewood Area)

Blehealth•Los Angeles, CA

13h•Remote

About The Position

The Lead Care Manager (LVN) collaborates with chronically ill or high-risk members, their families or caregivers, healthcare providers and staff, and community resources to coordinate care and deliver Enhanced Care Management (ECM) services. The role supports members through care planning, provider coordination, transitions of care, referrals, health education, and connections to medical, social, and community services. Services may be provided where members live, seek care, or can most easily access them, in accordance with Plan guidelines. This is a remote role, with occasional required reporting to a satellite office or other specified location for work, meetings, or training. The LVN visits hospitals and members’ homes as needed and must maintain reliable transportation, a valid driver’s license, proof of insurance, and a good driving record. A negative TB test, BLS/CPR certification, and completed Live Scan fingerprint/background check are required before the hire date. The position requires meeting a minimum daily expectation of 30 schedules per day.

Requirements

Current, valid California LVN license.
At least 1 year of experience.
Bachelor’s education listed in the posting.
Valid driver’s license, proof of insurance, and a good driving record.
Reliable means of transportation and ability to visit hospitals and members at home as needed.
Negative TB test and BLS/CPR certification before the hire date.
Completion of a Live Scan fingerprint/background check.
Proficiency with communication technologies such as email and cell phones.
Strong organization skills and ability to maintain accurate notes and records.
Excellent analytical, problem-solving, and prioritization skills.
Excellent verbal and written communication skills and strong interpersonal skills.
Ability to work collaboratively and tactfully with multidisciplinary and diverse teams, including employees, customers, and physicians.
Effective computer skills, particularly Microsoft Office, Excel, PowerPoint, and Word.
Ability to work independently and complete assigned tasks.
Ability to meet a minimum daily expectation of 30 schedules per day.

Nice To Haves

Experience with Health IT systems and reports.
Local knowledge of and connections to community healthcare and social welfare resources.
Bilingual ability in Chinese, Mandarin, or Spanish.

Responsibilities

Coordinate with members, families or caregivers, providers, and community resources to support seamless care and avoid duplication of services.
Engage eligible members and oversee ECM services and implementation of care plans.
Connect members to social services, community supports, and transportation; arrange transportation as needed.
Advocate for members with healthcare professionals and use motivational interviewing, trauma-informed care, and harm-reduction approaches.
Coordinate with hospital staff on discharge plans and accompany members to office visits as needed and within Plan guidelines.
Monitor treatment and medication adherence, provide health promotion and self-management training, promote timely access to appropriate care, and encourage preventive care.
Work to reduce emergency room use and hospital readmissions and improve members’ understanding through culturally and linguistically appropriate education.
Develop care plans in coordination with members, primary care providers, and family or caregivers; plans may include an emergency plan, health management plan, medical summary, and ongoing action plan.
Manage continuity of care, including relationships with tertiary care providers, transitions of care, and referrals.
Support members’ self-management and shared decision-making and connect them to resources that promote health and well-being.
Follow up with members, caregivers, providers, and community resources through face-to-face visits, secure email, phone calls, text messages, and other communications.
Serve as a contact point, advocate, and informational resource for members, care teams, caregivers, payers, and community resources.
Assess unmet health and social needs; monitor care-plan adherence and effectiveness, track progress, and facilitate changes as needed.
Establish ongoing processes for members and caregivers to identify and request their desired level of care-coordination support.
Facilitate access to medical and specialty providers and educate members and caregivers about relevant community resources.
Facilitate and attend meetings involving members, caregivers, care teams, payers, and community resources as needed.
Support primary care and specialty provider co-management through timely communication, inquiry, follow-up, and integration of information into care plans regarding transitions and referrals.
Help identify high-risk members and add them to the member registry or flag them in the EHR.
Attend Lead Care Manager training courses, webinars, and meetings and provide feedback to improve the ECM Program.
Call members to coordinate home or hospital visits as needed.
Meet the minimum daily expectation of 30 schedules per day.