Case Manager-LVN

Department

UHC:
Managed Care

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.

• Preferred:
  Bachelor's Degree
• Required:
  
  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
• Experience may be considered in lieu of Degree

• 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 30 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

• 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

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