Case Manager, LVN

Job ID
2021-153968
Employment Type
Full Time
Department
Case Management
Hours / Pay Period
80
Facility
Dignity Health Management Services Organization
Shift
Day
Standard Hours
8am-5pm
Work Schedule
8 Hour
Location
CA-Bakersfield

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

Responsibilities

The Case Manager, LVN is an integral part of Dignity Health Management Services Utilization Management team. The Utilization Management team improves the quality of clinical outcomes for members with complex care needs by coordinating care within the health care delivery system using a collaborative partnership approach. The Case Manager, LVN coordinates care and collaborates with multiple disciplinary team members across the continuum of care. The Case Manager, LVN implements the care plan collaborating with the RN and SW to identify patient knowledge gaps concerning disease management, and coordinates appropriate resources or services required to meet an individual's health needs.

 

The Case Manager, LVN promotes quality cost effective outcomes with the goal of improved care coordination and increased involvement of the individual/family/caregiver in the decision making process to reduce hospitalizations, readmissions and ER utilization. Conducts medical necessity, level of care, and benefit reviews rendered in the inpatient and outpatient setting to ensure the member receives the highest level of care. Coordinates with providers, provider staff, hospital staff, patients and patient family members to establish the appropriate level of care.

Qualifications

  • 5 years experience working in a medical facility, hospital, or other healthcare related environment. Managed care experience preferred.
  • Two years experienced working with a medical group or IPA preferred. Familiar with regulatory requirements for managed care, HMO?s and EPO?s.
  • Proficiency with health plan criteria/benefits and regulatory requirements as they relate to patient management across the continuum of care.
  • Proficient with standardized criteria, Interqual, MCG, Medicare, etc.
  • Current California LVN license required.
  • Must meet hospital credentialing requirements to obtain facility ID.

 

 

Preferred

  • Experience with DHMSO Online, QNXT, desired. Ability to perform job functions independently and with minimal supervision.
  • Excellent communication skills; able to read, write, and speak articulately, using established channels of communication and reporting relationships within the organization.
  • Ability to communicate effectively with all levels of internal/external staff, management, members, physicians/physician office staff, families of members, outside agencies, etc.
  • Able to stay organized and flexible in a work environment with multiple assignments and changing priorities - Word processing, keyboarding and non scripted documentation skills -
  • Able to operate PC-based software program. Basic knowledge of CPT and ICD9/ICD10 coding.
  • General knowledge of Microsoft Office applications; Excel, Word, Outlook; CA LVN license.

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