LVN Case Manager ( Concurrent Review)
Company: Judge Healthcare
Posted on: May 1, 2021
Case Management opening in Orange, California. This and other
lpn/lvn jobs brought to you by NursingJobCafe.com Our client is
currently seeking a Medical Case Manager (LVN) (Concurrent Review)
in Orange, CA!
This position provides case management intervention on behalf of
members with short term, stable, and predictable courses of
illnesses. Responsible for answering the medical appropriateness,
quality, and cost effectiveness of proposed
hospital/medical/surgical services in accordance with established
This job will have the following responsibilities:
- Analyzes requests with the objective of monitoring utilization
of services, this includes medical appropriateness and identifying
potential high cost, complex cases for outpatient case management
- Reviews and evaluates proposed services utilizing medical
criteria and/or established policies and procedures.
- Determines the appropriate action for the service being
requested for approval, modification, or denial, and refers to the
Medical Director for review when necessary.
- Reviews inpatient setting requests to determine if surgery
and/or medical care is appropriate.
- Identifies diagnosis and determines need for continuing
hospitalizations; monitors the inpatient length of stay as per
established guidelines and professional judgment.
- Initiates contact with patient, family, and treating physicians
to obtain additional information or to introduce the role of case
management as needed.
- For short-term cases, conducts a thorough and objective
assessment of the member's status including physical, psychosocial,
- Develops, implements, and monitors a care plan through the
interdisciplinary team process in conjunction with the individual
member and family in internal and external settings across the
continuum of care.
- Provides cost analysis, quality of care and/or quality of life
improvements as measured against the case management goals.
- Assesses member's status and progress; if progress is static or
regressive determines reason and encourages appropriate referrals
to out-patient case management or make appropriate adjustments in
the care plan, providers and/or services to promote better
- Establishes means of communication and collaboration with other
team members, physicians, community agencies, and
- Prepares and maintains appropriate documentation of patient
care and progress within the care plan.
- Acts as an advocate in the client's best interest for necessary
funding, treatment alternatives, timelines and coordination of care
and frequent evaluations of progress and goals.
- Collaborates with staff members from various disciplines
involved in patient care with an emphasis on interpreting and
problem and solving complex cases.
- Documents clinical information into the case notes along with
the rationale for all decisions in the Guiding Care system.
- Other projects and duties as assigned.Qualifications &
- High School diploma or equivalent required.
- Current, unrestricted Licensed Vocational Nurse (LVN) to
practice in the State of California required.
- 3+ years of Clinical Nursing Experience of which 1+ years
experience in a Managed Care setting required.
- 1+ years of Concurrent Review (In-Patient) experience highly
Keyphrases: medical case management jobs, case manager jobs, case
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Keywords: Judge Healthcare, Orange , LVN Case Manager ( Concurrent Review), Executive , Orange, California
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