Case Manager - LVN/RN *Hybrid*

About the Role

We are currently seeking a highly motivated Case Manager. This role will report to a Manager - Case Management and enable us to continue to scale in the healthcare industry, focusing on SNF, SA, ARU, LTAC level of care.

What You'll Do :

• Comply with Case Management Department’s policies and procedures.
• 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management
• Utilize Milliman Care Guidelines, CMS, Title 22 guidelines and criteria for appropriateness of transition of care for members in SNF, SA,ARU, LTAC setting.
• Collaborating with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission
• Responsible for coordinating the required initial and concurrent reviews based on the review of medical records received and accurate reporting of all admissions to Medical Director and Manager and / or Supervisor of Case Management Department
• Review of medical records and / or other documentation to determine medical necessity, appropriateness and level of care utilizing Milliman Care and other appropriate Guidelines
• Assess, plan, implement, coordinate, monitor, and evaluate all options and services with the goal of reducing hospital readmission
• Attends / coordinates Case Management meetings on and off-site as necessary
• Interacts with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements
• Attend to provider and interdepartmental calls in accordance with exceptional customer service
• Maintain good relationships with health plans, facilities and medical directors. Resolve problems that arise with any IPA medical directors.
• Report to Manager and / or Supervisor of Case Management on activities and / or problems occurring throughout the day

Qualifications :

• Active Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license in California
• Ability to commute to our Monterey Park, CA office
• Experience using Microsoft applications such as Word, Excel and Outlook
• Two (2) years of clinical experience as an LVN
• Skilled Nursing Facility experience a plus

You're great for this role if :

• Excellent analytical critical reasoning
• Proven ability to prioritize multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlines
• Ability to educate and train staff members and other departments as needed
• Experience using EZCAP
• Strong communication and customer service skills
• Punctual, Creative, self-motivated.
• Professional appearance and conduct.
• Conceptual and big picture understanding.
• Able to function independently under time constraints.
• Willing to learn and develop new responsibilities and skills.
• Good organization, critical thinking and problem solving skills.
• Must be detail-oriented and able to work autonomously but also as a team member.
• Have experience in SNF case management
30+ days ago