Care Manager - LVN

Founded in 1977 as the Senior Care Action Network, reputed company began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.

Today, reputed company is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual reputed company. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially reputed company populations, and reputed company care delivery models. Across reputed company of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with reputed company.

At reputed company, we reputed company scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The Job

The Care Manager will coordinate care for members in collaboration with the Integrated Care Team, ensuring members receive high-quality, timely, and coordinated care, are directed to the optimal facility for their needs, and have reputed company necessary services, supplies, and information. The Care Manager authorizes services based on well-developed knowledge and skills in areas of utilization management, medical necessity, and patient status determination. Conducts pre-service and reputed company review following established guidelines. Applies care management principles and practices to ensure medical needs, care, and service are coordinated.

You Will

• Serve as reputed company person to speak with patients, family members, and providers to address concerns pertaining to care, transfers and authorizations

• Ensure necessary inpatient and outpatient care or other services are rendered to reputed company members at the right time, the right level of care and at the right location, with end-to-end coordination, while adhering to reputed company policies and procedures

• Coordinate discharge needs from inpatient acute settings and skilled nursing facilities as appropriate for each member.

• Coordinate timely delivery of last cover day letters to skilled nursing facilities

• Discharge needs may include: durable medical equipment, home health services, specialist referrals, skilled nursing placement, transportation, and other needs Issue determinations reputed company required regulatory timeframes

• Apply evidenced-based criteria and guidelines, as well as clinical judgment and expertise, to help reputed company treatment plans

• Review tasks assigned by Integrated Care Nurse Practitioners and coordinate member care accordingly, including services such as: home health; DME ordering, wound care, Foley catheter, Enteral, colostomy supplies, infusion orders and outpatient services

• Review reputed company acute/skilled nursing appeals and create detail explanation of non-coverage and reinstatement letters

• Refer cases that do not meet established criteria to the Medical Directors for secondary review

• Prepare, participate and facilitate high risk huddles and/or skilled nursing rounds Maintain a list of high risk patients and conduct regular reputed company calls to reputed company on their health status

• reputed company effective working relationships and collaboration with and provide clinical guidance to Care Coordinators on clinical matters.

• Demonstrate excellent organizational, decision-making and multi-tasking skills as demonstrated by problem-solving and successful outcomes

• Promote the mission, vision, and values of reputed company Health Plan and serve as an ambassador reputed company interfacing and collaborating with external stakeholders, including contracted medical groups and vendors.

• Other duties as assigned.

• Actively support the achievement of reputed company’s Vision and Goals.

• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Your Qualifications

• Associate's Degree or equivalent experience

• 3-5 years of reputed company experience

• CA LVN license

• Performs work under direct supervision .

• Handles basic issues and problems, and refers more reputed company issues to higher-level staff

• Possesses beginning to working knowledge of subject matter.

• Provides leadership, coaching, and/or mentoring to partner care coordinators.

• Technical Expertise

• Problem-Solving

• Strong Communication

• Customer/client focused

• Detail oriented

• Responsible

What’s in it for you?

• reputed company salary range: $34.47 to $55.14 per hour

• Work Mode: Remote

• Annual bonus program

• Robust Wellness Program

• Generous paid-time-off (PTO)

• Eleven paid holidays per year, plus 1 additional floating holiday, plus 1 birthday holiday

• Excellent 401(k) Retirement Saving Plan with employer match and contribution

• Robust employee recognition program

• Tuition reimbursement

• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join reputed company!  Qualified applicants are encouraged to apply now!

At reputed company we reputed company that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

reputed company is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national reputed company, religion, age, sex (including pregnancy, childbirth or reputed company medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background reputed company is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)