Case Manager LVN
Reports to: Department Manager
Department: Global Health Services
Calibrated Healthcare Network (CHN) manages over 11 million lives in over 8 states, partnering with industry leaders in the area of managed care. Our operating model features global workforce strategies, coupled with efficient technological solutions. We have a proven expertise in re-engineering complex managed care business processes to provide value to our esteemed partners. Our commitment to the evolution of healthcare is evident in our investment in research and development for the progression of dynamically enhanced technology to meet the needs of partners. The core suite of services includes Claims Adjudication, Benefits Setup, Member Enrollment and Eligibility Setup, Claims System Configuration, HCC Coding and MSO Development support.
The Calibrated Clinical Solution (CCS) global workplace is built on the concept of providing cost-effective care, enhancing population health strategies, and improving the quality of care. Calibrated Clinical Solutions deploys the use of proprietary software to create cost-effective workforce solutions constructed on the premise of collaboration technology. With our extensive domain of knowledge of managed care and dynamically enhanced technology, we have the capacity to create innovative solutions for our managed care and primary practice partners. Our core suite of services includes Medical Management, Utilization Management, Complex Case Management, and Population Health Management.
Under the general direction of the RN Case Manager, the CM Coordinator is responsible for facilitating care coordination needs of a defined population. The LVN CM provides case management support for health education, health coaching, self-management, and transition of care within the defined scope of practice for a licensed vocational or practical nurse.
- Associates Degree preferred
- Active Unrestricted license as a Vocational (LVN) or Practical nurse (LPN)
- 1-year managed care experience preferred
- Previous case management experience preferred
- Core Competencies: Ethics and Values, Customer Focus, Action-Oriented, Learning on the Fly, Manage/Measure Work, Drive for Results, Priority Setting, Timely Decision-Making, Organizing, Functional and Technical Skills
- Demonstrated ability to work together across professions and individuals to improve health outcomes.
- Computer Proficiency (MS Word, MS Excel, MS Outlook, Video Conferencing)
- Capacity to interpret evidenced based guidelines (Interqual and/or Milliman criteria sets), health plan/client specific chronic care guidelines, and policies/procedures
- Knowledge of NCQA, DMHC, and state requirements for case management
Essential Functions of Job
- Under the general direction of the RN CM, responsible for the execution of care plan interventions for an assigned group of patients.
- Responsible for accurate and timely completion of the data collection processes for an assigned group of patients.
- Responsible for providing evidenced-based self-management strategies, health coaching, and health education to the assigned population.
- Responsible for updating the care plan based on care coordination activities for members open to case management.
- Conducts ongoing follow-up with the individual, family and/or family caregiver in the evaluation of care coordination activities
- Responsible for adherence to the policies and procedures for the Contact Center; to include, but not limited to, managing the outbound call queue to collect data for health risk assessments, coordinate care for care gap closures, or specialty referral tracking.
- Responsible for transition of care outreach, coordination, and information exchange per policies and procedures.
- Ensures compliance with desktop procedures for appropriate documentation