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LVN Case Manager ( Concurrent Review)

Company: Judge Healthcare
Location: Orange
Posted on: May 14, 2022

Job Description:

Case Management opening in Orange, California. This and other lpn/lvn jobs brought to you by

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 criteria.

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 intervention.
  • 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, and environmental.
  • 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 outcomes.
  • Establishes means of communication and collaboration with other team members, physicians, community agencies, and administrators.
  • 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 & Requirements:

    • 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 preferred.

      Keyphrases: medical case management jobs, case manager jobs, case manager consultant jobs, case management consultant jobs, geriatric case management jobs, case management nursing jobs, nurse case manager jobs

Keywords: Judge Healthcare, Orange , LVN Case Manager ( Concurrent Review), Healthcare , Orange, California

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