• LVN Case Manager

    Location US-CA-Los Angeles
    Job ID
    2018-7079
    Category
    Nursing
  • Overview

    The LVN Case Manager may provide daily care coordination, case management, coaching, consultation and intervention to patients with one or more chronic diseases. May also be responsible for identifying said population via provider/clinic referral, utilization management referral, disease registry reporting mechanisms and patient self-referral. This position may also provide case management to patients who are admitted to the hospital and those patients who may need to be enrolled in ambulatory case management. The LVN case manager will be responsible for identifying (California Children Services) CCS cases, handle transfers, and retro reviews. Works as part of an interdisciplinary care team coordinating social work and mental health counseling, psycho-social support services, in-home support, legal services, skilled nursing, home health, etc. Effectively collaborates with the hospitalist, the hospital nursing personnel, with members of the interdisciplinary care team and with the physician in the clinic.

    Responsibilities

    1. May be responsible for daily concurrent reviews, retro reviews, discharge planning, pre-certification/prior authorization request review, and ensures patients meet appropriate level of care based on acceptable evidence-based Clinical Criteria(s).
    2. Effectively and efficiently manages patients throughout the continuum of care.
    3. Works collaboratively with Hospitalists, hospital partners, and care teams to provide holistic patient care that is focused on high quality in a cost effective way.
    4. Will participate in the developing of all program material, Policies and Procedures related to the nurse case management program; may also develop program informational and educational materials and various forms.
    5. Develops a working relationship with the hospital case managers, health plan, clinics, hospitalists and other governing entities.
    6. Identifies and enrolls patients into a case management program providing intensive service.
    7. May assist with the process of patient intakes and assessments per health plan and department’s policy.
    8. Identifies needs and develops individualized care service plans on behalf of clients; an active participant in case conferences; attends divisional coordinators meetings and regular staff meetings; re-evaluates patients as needed; monitors the services delivered by team participants.
    9. Works with hospital discharge planners and assists in the coordination of support services.
    10. Attends Joint Operation Committee (JOC) meetings and various community meetings as needed.
    11. Responsible for the daily review and processing of referral authorizations in accordance to turnaround time (TAT) standards set by ICE/Health Plan requirements.
    1. Monitors ongoing services and their cost effectiveness; recommending changes to the plan as needed using clinical evidence-based criteria – Milliman, Interqual, CMS, National Recognized American Academy of Specific Specialty.
    1. Assists with composing medical director denials to meet language requirements set by ICE/Health Plan requirements.
    2. May assist in performing and documenting patient telephonic and/or person-to-person risk assessments as needed.
    3. Performs other related duties as assigned.

    Measurements of Success:

    I. MEETS PERFORMANCE REQUIREMENTS

    • Meet the established Performance & Productivity Targets. Measurement: department’s Performance Metrics.
    • Effective time management demonstrated by meeting the established turn-around times and all regulatory and health plan requirements. Measurements: 100% of audits completed and documents submitted within the required time line.       No more than three CAPS per health plan per audit.
    • Managing multiple priorities, demonstrated by ease and productivity to transition between multiple tasks. Measurement, Department Performance Measure.
    • Team player, achieved through assisting co-workers with their workload as asked by the Lead or others and be able to have cross-training to fill in when needed.
    • Basic analytics understanding to track manage and report outcomes of the referral numbers and escalate issues impacting the TAT.
    • Highly effective communication with members, external constituents, and internal stakeholders.

     

    II. EXCEEDS PERFORMANCE REQUIREMENTS

    All items listed under “Meets Expectations”, and:

     

    • Problem solving skills demonstrated by identification, recommendation, and implementation of tactics and approaches to improve productivity and team work.
    • Taking initiations demonstrated by consistent and active offer participation to be a positive change agent, to problem solve, identify and offer suggestions to improve outcomes in Case Management, and to assist others as needed.
    • Leading by example. Be the role model in offering supportive care to patients, and consistently meet needs of the external and internal customers.

    Qualifications

    1. Graduation from an accredited LVN nursing program.
    2. Current valid License as a Licensed Vocation Nurse
    3. Experience in and willingness to be part of multi-disciplinary team.
    4. Experience with physically or mentally impaired adults and/or geriatric population.
    5. Three years experience in public health nursing, acute care, case management and/or in-home health care required; minimum of 2 years of managed care experience in case management with focus in inpatient and/or outpatient ambulatory care preferred.
    6. Bilingual in English and Spanish preferred.

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Connect With Us!

    Not ready to apply? Connect with us for general consideration.