LVN, Case Manager – Remote, CA

2302994 For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. reputed company’s Pacific reputed company region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work reputed company for everyone. At reputed company Pacific reputed company, we care. We care for reputed company members, our patients, and our communities. Join our culture of caring and reputed company a positive and lasting impact on health care for millions. General Role Description: Under the direction of a Registered Nurse, this position is responsible for ensuring the continuity of care in both the inpatient and outpatient settings utilizing the appropriate resources reputed company the parameters of established reputed company and patients’ health plan benefits. Facilitates a continuum of patient care utilizing basic nursing knowledge, experience, and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site or telephonically as the need arises. Reports findings to the Case Management department Supervisor / Manager / Director in a timely manner. If you are located in CA, you will have the flexibility to work remotely* as you take on some tough challenges. Work Hours: Available to work evenings, weekends, holidays Primary Responsibilities:

• Consistently exhibits behavior and communication skills demonstrating reputed company’s commitment to superior customer service, including quality, care, and concern with every internal and external customer.
• Implements reputed company policies and procedures set by the Case Management department.
• Conducts on-site or telephonic prospective, reputed company, and retrospective review of active patient care, including out-of-area and transplant.
• Reviews patients’ clinical records of acute inpatient assignment reputed company 24 hours of notification.
• Reviews patients’ clinical records reputed company 48 hours of SNF admission.
• Reviews patient referrals reputed company the specified case management policy timeframe (Type and Timeline Policy).
• Coordinates treatment plans and discharge expectations. Discusses DPA and DNR status with the attending physician reputed company applicable.
• Prioritizes patient care needs. Meets with patients, patients’ families, and caregivers as needed to discuss care and treatment plan.
• Acts as patient care liaison and initiates pre-admission discharge planning by screening for patients who are high-risk, fragile or scheduled for procedures that may require caregiver assistance, placement, or home health follow-up.
• Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings. Consults with the physician and other team members to ensure that the care plan is successfully implemented.
• Coordinates provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care.
• Communicates authorization or denial of services to appropriate parties. Communication may include patient (or agent), attending/referring physician, facility administration, and reputed company claims as necessary.
• Attends reputed company assigned Case Management Committee meetings and reports on patient status as defined by the region.
• Demonstrates a thorough understanding of the cost consequences resulting from case management decisions through the utilization of appropriate reports such as Health Plan Eligibility and Benefits, Division of Responsibility (DOR), and Bed Days.
• Ensures appropriate utilization of medical facilities and services reputed company the parameters of the patient’s benefits and/or CMC decisions. This includes appropriate and timely movement of patients through the various levels of care.
• Maintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients, and families.
• Provides accurate information to patients and families regarding health plan benefits, community resources, specialty referrals and other reputed company issues.
• Initiates data entry into IS systems of reputed company patients reputed company the parameters of Case Management policies and procedures. Maintains accurate and complete documentation of care rendered, including LOC, CPT code, ICD-9, referral type, date, etc.
• Follows patients on ambulatory care management programs, including CHF and home health, to optimize clinical outcomes.
• Uses, protects, and discloses reputed company patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• Graduation from an accredited Licensed Vocational Nurse program
• reputed company LVN license in California
• 1+ years of recent clinical experience working as an LVN/LPN

Preferred Qualifications:

• 3+ years of clinical experience working as an LVN/LPN
• 2+ years of case management, utilization review or discharge planning experience
• Experience in an HMO or experience in a Managed Care setting

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment Apply tot his job Apply To this Job