Case Manager LPN - Remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global scale. 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. Position in this function is 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 Care Management department Supervisor / Manager / Director in a timely manner. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

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 Care 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 care 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 Care Management Committee meetings and reports on patient status as defined by the region Demonstrates a thorough understanding of the cost consequences resulting from care 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 Care 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, in order 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 compact license reputed company CA LVN license or willing to obtain 1+ years of recent clinical experience working as an LVN/LPN Preferred Qualifications: 2+ years of care management, utilization review or discharge planning experience Experience in a Managed Care setting *reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy 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 - $36.00 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply To This Job