Case Manager-LVN - Loma Linda University

Job Summary: The Case Manager-LVN is responsible for case management of the patient/family across the health care continuum, to include those with complex medical, socio-economic, and mental health co-morbidities. Case Manager-LVN is responsible for utilization management, disease management, complex case management and inpatient care management in a telephonic and/or onsite care management position.  Reviews inpatient and outpatient services to determine medical appropriateness following evaluation of medical guidelines and benefit determination. This role acts as a support to team members, coaching and providing feedback as necessary. The LVN-Case Manager will act as a patient/family advocate guiding them through the Health Care system for transition planning. The LVN-Case Manager will participate in on-call rotation after-hours and/or on weekends as needed to meet contractual obligations and provide decision support on managed care issues. Performs other duties as needed.

Education and Experience: Bachelor's Degree preferred. Graduate of a school of Licensed Vocational Nursing (LVN) required.  Minimum five years experience in managed care required.  Minimum two years ambulatory care management program and/or case management experience required.   Experience may be considered in lieu of Degree

Knowledge and Skills: Knowledge of lines of business (LOB � Commercial � United Health Care, Anthem Blue Cross, Blue Shield of California, Medicare Advantage, ACO,); Proficient in application of MCG for both inpatient and ambulatory care.  Knowledge of utilization management processes and current standards of care as a foundation for utilization review and transition planning.  Knowledge and ability to comply with health plan audits.  Ability to interpret CMS including Medicare Managed Care Manual.    Able to keyboard 40 wpm � test required.   Read; write legibly; speak in English with professional quality; use computer, printer, and software programs necessary to the position (e. g., Word, Excel, Outlook, PowerPoint).  Operate/troubleshoot basic office equipment required for the position.  Relate and communicate positively, effectively, and professionally with others; work calmly and respond courteously when under pressure; collaborate and accept direction.  Bilingual preferred.  Communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision.   Distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.

Licensures and Certifications: Active California Licensed Vocational Nurse (LVN) required. Basic Life Support (BLS) certification from the American Heart Association (AHA) required.  Certified Managed Care Nurses from the American Association of Managed Care Nurses within two years of hire.