Care Management - LVN, Senior

Your Role 

The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Senior LVN, Care Manager, will report to the Manager of Care Management. In this role you will work in the Outreach and Enrollment department and play a pivotal role in reaching out to our members, assessing their needs, and providing comprehensive care coordination. This position requires a proactive individual who can successfully engage and connect members to appropriate health programs and resources.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work 

In this role, you will: 

• Conduct thorough assessments of member needs, including physical, mental, and social health aspects

• Identify appropriate programs and services that align with member needs and preferences

• Provide Referrals to Quality Management (QM), Disease Management (DM), Complex Care Management (CCM), and Appeals and Grievance department (AGD) 

• Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team 

• Coordinate with healthcare providers, social workers, and other team members to ensure seamless delivery of care services

• Provide education and support to members and their families regarding health conditions, treatment options, and community resources

• Follow up with members as appropriate to ensure they have successfully connected with recommended programs and services 

Your Knowledge and Experience 

• Requires a High School Diploma/GED and completion of a state-approved Vocational Nursing (LVN) program

• Requires a current and unrestricted CA LVN License

• Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements

• Requires at least 5 years of prior experience in nursing, healthcare or related field

• Requires experience working at a health plan (managed care, government payer, or academic)

• A minimum of 3 years’ experience in inpatient, outpatient, and/or managed care environment required

• Excellent communications skills

• Bilingual is preferred

• Excellent communication and interpersonal skills, with the ability to engage and build rapport with diverse populations

• Demonstrated ability to independently assess, evaluate, and interpret clinical information

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.