Medical Case Manager

Company: HealthEcareers - Client
Location: Orange
Posted on: September 3, 2024

Job Description:

CalOptima Health is seeking a highly motivated an experienced Medical Case Manager (LVN) (NOA) to join our team. The Medical Case Manager LVN for Notice of Action (NOA) is responsible for providing NOA coordination for CalOptima Health's Utilization Management clinical determinations. The incumbent will facilitate communication and coordination among all participants involved in the NOA process to promote quality and cost-effective outcomes. The incumbent will provide intensive coordination in a process that includes assessment, planning, facilitation, implementation, coordination, monitoring and evaluation of the NOA process.Position Information:

• Department: Utilization Management
• Salary Grade: 311 - $77,863 - $124,581 ($ $
• Work Arrangement: Partial Telework**This position is eligible for telework in California.**Duties & Responsibilities:
  • 85% - Program Support
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Performs comprehensive assessment of all identified NOAs which includes but is not limited to assessment of the reason for the NOA, coordination with physician reviewers and NOA production and compliance.
  • Develops and implements member specific NOA letters.
  • Communicates with CalOptima Health's physician reviewers, members' physicians, specialists, community agencies and vendors to ensure accurate and complete clinical information is presented.
  • Follows CalOptima Health's protocol for documentation.
  • Works collaboratively with interdepartmental staff for NOA resolution.
  • Identifies cases needing review or input from a manager, director or Medical Director and routes accordingly.
  • Processes NOAs with the highest degree of nursing judgment and accuracy.
  • Closes cases according to defined case closure procedure in a timely manner and in accordance with established guidelines.
  • 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, coordination of care and frequent evaluations of progress and goals.
  • 10% - Administrative Support
  • Develops desktop procedures, assessments and referral templates to facilitate the implementation and compliance with new case management programs or requirements.
  • 5% - Completes other projects and duties as assigned.Minimum Qualifications:
    • High school diploma or equivalent required.
    • 3 years of clinical experience required, 1 year of which must be as a UM Clinical Nurse Reviewer or NOA processor.
    • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.Preferred Qualifications:
      • 3 years of managed care experience.Required Licensure / Certifications:
        • Current, unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California required.Knowledge & Abilities:
          • Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
          • Work independently and exercise sound judgment.
          • Communicate clearly and concisely, both orally and in writing.
          • Work a flexible schedule; available to participate in evening and weekend events.
          • Organize, be analytical, problem-solve and possess project management skills.
          • Work in a fast-paced environment and in an efficient manner.
          • Manage multiple projects and identify opportunities for internal and external collaboration.
          • Motivate and lead multi-program teams and external committees/coalitions.
          • Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.Work Environment:If located at the 500, 505 Building or a remote work location:
            • Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
            • There are no harmful environmental conditions present for this job.
            • The noise level in this work environment is usually moderate.If located at PACE:
              • Work is typically indoors in a clinical setting serving the frail and elderly.
              • There may be harmful or hazardous environmental conditions present for this job.
              • The noise level in this work environment is usually moderate to loud.If located in the Community:
                • Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
                • Employee will occasionally work outdoors in varied temperatures.
                • There may be harmful or hazardous environmental conditions present for this job.
                • The noise level in this work environment is usually moderate to loud.About CalOptima Health:CalOptima Health is the single largest health plan in Orange County, serving one in four residents. Our motto - "Better. Together." - is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community's health. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stayAbout our Benefits & Wellness options:At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Monday or Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options. For more information, please click on the regarding our comprehensive benefits and wellness package.To apply and see full details, please visit: Compensation Information:
                  $ / Annually - $ / Annually
                  
                  Starting At: Annually
                  Up To: Annually

Keywords: HealthEcareers - Client, Orange , Medical Case Manager, Executive , Orange, California