LVN Case Manager

Serene Health•San Diego, CA

7d•$68,640 - $83,200•Hybrid

About The Position

Empowering Wellness, Transforming Lives Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being. As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities. Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people's lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members. A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual's contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work! Job Summary: We are seeking a dedicated and compassionate Licensed Vocational Nurse (LVN) Case Manager to join our dynamic healthcare team. The LVN Case Manager will be responsible for overseeing a diverse caseload, coordinating patient care, conducting medical necessity reviews, and ensuring regulatory compliance. The ideal candidate will possess excellent clinical skills, strong organizational abilities, and a passion for patient advocacy. This role involves both in-person and telehealth interactions to effectively manage treatment plans and patient relationships.

Requirements

Current and valid Licensed Vocational Nurse (LVN) license in the state of California required.
Associate or Bachelor’s degree in nursing, healthcare/business administration, or equivalent experience required.
Minimum of 2 years of clinical nursing experience in a medical setting (e.g., office, hospital, SNF, medical clinic) required.
Minimum of 1 year of experience in a managed care or healthcare environment related to Case Management.
Current BLS certification required.

Nice To Haves

Experience in managed care, palliative care, hospice, or neurology preferred.
Experience with virtual care and telemedicine preferred.
Knowledge and experience in working with homeless individuals and marginalized populations preferred.
Experience in acute care and/or ICU/CCU settings preferred.
Experience with Medicare and Medi-Cal environments preferred.
Certification in Case Management (e.g., CCMC or ARN) preferred.
Knowledge of Core Measures and basic statistics preferred.
Bilingual in English and Spanish preferred.

Responsibilities

Perform comprehensive assessments of patients' medical, psychosocial, and functional needs.
Develop, implement, and revise individualized care plans, monitoring progress toward patient goals.
Facilitate smooth transitions between different levels of care, including post-discharge visits and coordinate care between patients, ER, hospitals, and Urgent Cares.
Provide ongoing support and case management in accordance with the case/treatment plan and Transfer of Care.
Oversee the day-to-day administrative duties of the department.
Perform audits to ensure quality assurance.
Conduct clinical/medical necessity reviews and authorize services that meet medical criteria.
Act as a liaison between patients, families, healthcare providers, and community resources.
Maintain accurate and up-to-date patient records in accordance with regulatory and organizational standards.
Keep current with knowledge and understanding of applicable accreditation and regulatory statutes related to healthcare, managed care, and case management practice.
Performs other duties as assigned.

Benefits

Medical, Dental, & Vision Benefits
Short & Long-Term Disability Benefits
Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans
Flexible Spending Accounts
Employee Assistance Program (EAP)
401(K)
Paid Vacation and Sick Leave
Paid Holidays
Employee Referral Program
Company Discount Program