Episodic Case Manager LVN

Summary

Under the direct supervision of the Leads & RN Clinical Manager for Case Management, the RN/LVN Case Manager is responsible for assessing, planning, implementing monitoring and evaluating options and services to develop a patient focused action plan for their patients. The RN/LVN Case Manager acts as patient advocate through the continuum and is available to the physician, patient, and family as a resource to facilitate communication. As patient advocate, he/she also monitors patient care to ensure that the patient receives quality care using standards of care and practice guidelines.

Duties and Responsibilities

· Performs medical, functional, safety, nutritional and psychosocial assessments on targeted assigned caseloads to evaluate the member’s needs and coordinate appropriate care. Documents issues, problems, appropriate interventions and follow up notes in preferred documentation module

· Provides open, sensitive timely communication with patients, families, and their significant others to participate in the patient’s care. Identify support systems from family and community resources.

· Participates in the Interdisciplinary Care Team (ICT) (as needed)/ Case Management (CM) Meetings/IPA Rounds as they relate to target cases.

· Provides coordination of care for members requiring assistance with specialist visits, durable medical equipment, home health, prior authorization, and other needs. Collaborates with Social Work team to coordinate care and services for targeted case load.

· Refers to Health Plan available/ eligible programs; Health Plan Complex Case Management, Disease Management, Palliative Care, MLTSS, etc. as needed.

· Maintains effective communication with health plans, physicians, hospitals, extended care facilities, members, MPM interdepartmental counterparts, and co-workers concerning the referral process.

· Ensures cases are coded accordingly to be able to maintain accurate reporting of members referred to health plan specific programs

· Adheres to HIPAA regulations and policies in relation to confidentiality of patient information that involves members, co-workers, etc.

· Assists with orientation and training for new employees as needed and performs or assume other duties as assigned. Must show initiative.

· Coordinates and completes other tasks as needed

Minimum Job Requirements:

· Current California RN/LVN License

· Acute Care experience, 1-2 years’ experience in Basic/ Complex Case Management a plus, 1 year experience in Managed Care. Must understand the managed care philosophy, including advanced knowledge of HMO policies and procedures and the managed care industry.

· Familiar with Case Management Policies and Procedures, standards of practice and its function. Must be able to manage diverse areas of understanding and interface effectively with all employees, members, employers, MPM personnel and providers.

· Must be able to triage, prioritize and identify what is urgent vs non-urgent and must be able to manage diverse areas of understanding and interface effectively with all employees, members, employers, MPM personnel and providers

Skill and Abilities

· Must be computer literate with basic office and computer skills.

· Must be detail oriented and possess strong communication skills, both verbal and written to document, assess and communicate with other staff members the plan of care which requires coordination.

· Bilingual is a plus

· EZ-CAP and ESSETTE knowledge a plus.