UM LVN Case Manager
at Ronin Staffing

Date Posted: 12/27/2019

Job Description

: UM LVN Case Manager 
Pay: DOE
Location: Commerce, CA 90040
Duration: 4 month contract with possible extension
Schedule: 8-5

Job Description:

The LVN Case Manager may provide daily care coordination, case management, coaching, consultation and intervention to patients with one or more chronic diseases.

We are looking for LVNs with some clinical experience in a hospital, skilled nursing facility, or a complex medical clinic. (No new graduates) In addition, we strongly prefer staff with some utilization management/ managed care background. The ideal candidate would have experience doing medical necessity reviews using Medi-Cal guidelines, NCDs, LCDs, MCG, and/or InterQual. Health Plan or MSO experience preferred.

Skills and Abilities:

1. Uses computer and computer system (including hardware and software) to perform necessary functions. 2. Communicates effectively in writing as for the needs of the audience.

3. Demonstrates excellent interpersonal skills.

4. Maintains dedicated attention to detail.

5. Analyzes and interprets reports and data for management purposes.

6. Demonstrate knowledge of DOFRs and delegation agreements

7. Adheres to the AltaMed Heath services HIPAA Compliance Plan and the Privacy Standards Confidentiality Agreement.

8. Knowledge of pre-authorizations and reimbursement regulations pertaining to Medicare, Medi-Cal, Commercial, CCS and other government programs

Essential Job Functions of Job Description

1. Responsible for the daily review and processing of referral authorizations in accordance to turnaround time (TAT) standards set by ICE/Health Plan

2. Works collaboratively with Hospitalists, hospital partners, and care teams to provide holistic patient care that is focused on high quality in a cost effective

3. Monitors ongoing services and their cost effectiveness; recommending changes to the plan as needed using clinical evidence-based criteria – Milliman, Interqual, CMS, National Recognized American Academy of Specific Specialty, Health Plan specific criteria.

4. Utilizes authorization matrix, ancillary rosters, DOFR, and/or delegation agreements to drive decision-making

5. Maintains up to date knowledge of rules and regulations governing utilization management processes;

6. Input data into the Medical Management system to ensure timeliness of referral processing.

7. Verifies member benefits and eligibility upon receipt of the treatment authorization request.

8. Ensure timely provider and member oral and written notification of referral decisions.

9. Coordinates with Medical Director or referral specialists for timely referral processing

10. Facilitates LOA processing by sending request to Provider Contracting for non-contracted providers or facilities, when applicable

11. Facilitates LOA processing with the Health Plan for non-contracted facilities

12. May be responsible for daily concurrent review, retro reviews, discharge planning, pre-certification/prior authorization request review and ensures

patients meet appropriate level of care based on acceptable evidenced based criteria.

13. Develops a positive working relationship with internal and external customers

14. Perform additional duties as assigned.

Required/Desired Skills:

  • Graduation from an accredited LVN nursing program – Required
  • Valid license as a Licensed Vocational Nurse – Required
  • Experience in and willingness to be part of multi-disciplinary team – Required
  • 3 years experience in public health nursing, acute care, case management and/or in-home health care – Required
  • 2 years of managed care experience in case management with focus in inpatient and/or outpatient ambulatory care – Required
  • Bilingual in English/Spanish – Desired

Job Snapshot

About Us

Founded in 1999 as a woman- and minority-owned IT staffing organization, Ronin Staffing has grown into a full-service staffing search firm that recruits and places qualified and quality candidates with expertise in a wide range of areas, including Engineering, Aerospace, Administration, Accounting/Financing, to name a few. We offer contract-only, contract-to-hire or direct-hire services to our clients and our contractors alike.

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