Episodic Case Manager, LVN

This is a fully remote position, open to applicants in California.

📋 Description

• Evaluate, plan, implement, monitor, and assess options and services to create patient-centered action plans.

• Act as an advocate for patients throughout their care journey and facilitate effective communication between physicians, patients, and families.

• Oversee patient care to guarantee quality services by utilizing established standards of care and practice guidelines.

• Conduct medical, functional, safety, nutritional, and psychosocial assessments for designated caseloads.

• Record issues, challenges, interventions, and follow-up notes in the designated documentation module.

• Communicate empathetically and promptly with patients, families, and significant others regarding care matters.

• Identify support systems from family and community resources to assist patients.

• Engage in Interdisciplinary Care Team, Case Management, and IPA meetings/rounds as required.

• Organize specialist appointments, durable medical equipment, home health services, prior authorization, and other member necessities.

• Work collaboratively with the Social Work team to coordinate care and services effectively.

• Refer members to eligible Health Plan programs, including Complex Case Management, Disease Management, Palliative Care, and MLTSS.

• Maintain communication with health plans, physicians, hospitals, extended care facilities, members, MPM departments, and colleagues regarding referrals.

• Ensure accurate coding of cases for reporting members referred to health plan programs.

• Comply with HIPAA confidentiality regulations and policies.

• Assist with the orientation and training of new employees as necessary.

• Carry out other assigned tasks and demonstrate initiative.

⛳️ Requirements

• Valid California RN/LVN License.

• Experience in Acute Care.

• 1–2 years of experience in Basic/Complex Case Management is advantageous.

• A minimum of 1 year of experience in Managed Care.

• Understanding of the managed care philosophy, with advanced knowledge of HMO policies, procedures, and the managed care industry.

• Familiarity with Case Management Policies and Procedures, standards of practice, and its functions.

• Ability to triage, prioritize, and discern urgent versus non-urgent issues.

• Capability to manage various areas of understanding and interact effectively with employees, members, employers, MPM personnel, and providers.

• Basic office and computer skills; proficiency in computer literacy.

• Attention to detail along with strong verbal and written communication abilities.

• Bilingual skills are a plus.

• Knowledge of EZ-CAP and ESSETTE is an advantage.

🏝️ Benefits

• 401(k)

• 401(k) matching

• Dental insurance

• Health insurance

• Vision insurance

• Wellness resources