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Summary
Under the direct supervision of the Regulatory Lead, 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. They collaborate with the primary physician and other healthcare team members to develop patient goals and actions, ensuring realistic and comprehensive care plans that address the needs of the patient and family. The role involves facilitating patient progression through the care continuum in collaboration with the healthcare team, patient, and community resources.
Duties And Responsibilities
Identify and monitor patients with complex conditions, providing education and direction within nursing scope. Coordinate medical services with PCPs or specialists and facilitate transitions between care levels, referring to community services as needed.
Participate in data collection and analysis to support care management outcomes and identify improvement opportunities.
Act as a patient advocate throughout the care process, facilitating communication among the physician, patient, and family, and ensuring quality care standards are met.
Conduct medical, functional, safety, nutritional, and psychosocial assessments to evaluate needs and coordinate appropriate care.
Document issues, interventions, and follow-up evaluations in compliance with regulatory requirements.
Communicate effectively and timely with patients, families, and team members to support patient care participation.
Participate in Interdisciplinary Care Team meetings related to assigned cases.
Maintain communication with managed care plans, providers, hospitals, and other stakeholders regarding referrals.
Collaborate with Social Work team to coordinate care and services.
Assist in preparing for health plan audits and ensure case readiness.
Perform additional duties as assigned and demonstrate initiative.
Assist with orientation and training of new staff as needed.
Minimum Job Requirements
Current California RN/LVN license
1-2 years of acute care experience; experience in case management and managed care preferred
Knowledge of managed care philosophy, HMO policies, and procedures
Understanding of case management policies and effective interface with healthcare stakeholders
Ability to triage and prioritize urgent vs non-urgent cases
Skills And Abilities
Basic computer skills and literacy
Strong communication skills, both verbal and written
Bilingual abilities are a plus
Knowledge of EZ-CAP and ESSETTE systems is a plus
Additional Details
Seniority level: Mid-Senior level
Employment type: Full-time
Job function: Healthcare Provider
Industry: Medical Practices
This job posting is active. Apply now to join MedPOINT Management as a Regulatory Case Manager, RN / LVN.