The LVN Case Manager will provide daily care coordination with concurrent review for patient in the hospital or Skilled Nursing Facilities (SNF) in person or telephonically. This position will also provide case management to patients who are admitted to the hospital or SNF and those patients who may need to be enrolled in ambulatory case management. The LVN case manager will be responsible for identifying (California Children Services) CCS cases, handle transfers, and retro reviews. Works as part of an interdisciplinary care team coordinating care and collaborating with social work, ambulatory case management, and Regional Medical Directors, Hospitalist, the hospital nursing personnel, and with the physician in the clinic.
Responsible for daily concurrent reviews, retro reviews, discharge planning, pre-certification/prior authorization request review, and ensures patients meet appropriate level of care based on acceptable evidence-based Clinical Criteria(s). (Interqual)
Follows established policies, procedures, workflows, and desktop procedures of the department.
Effectively and efficiently manages patients throughout the continuum of care.
Works collaboratively with hospitalists, hospital partners, and care teams to provide holistic patient care that is focused on high quality in a cost effective way.
Develops a working relationship with the hospital case managers, health plan, clinics, hospitalists and other governing entities.
Works with hospital discharge planners and assists in the coordination of support services.
Rounds daily with Regional Medical Director and hospitalists to collaborate on Plan Care and Discharge Plan.
Attends Joint Operation Committee (JOC) meetings and various community meetings as needed.
Responsible for the daily review and processing of referral authorizations in accordance to turnaround time (TAT) standards set by ICE/Health Plan requirements.
Assists in performing and documenting patient outreach telephonic and/or face to face to ensure safe, appropriate discharge planning to reduce the likelihood of readmissions and responsibilities includes but not limited to PCP appointments, ensure DME Home Health is ordered, referring for social barriers for referrals to social workers.
Performs other related duties as assigned.
Measurements of Success:
I. MEETS PERFORMANCE REQUIREMENTS
Meet the established Performance & Productivity Targets. Measurement: department’s Performance Metrics.
Effective time management demonstrated by meeting the established turn-around times and all regulatory and health plan requirements. Measurements: 100% of audits completed and documents submitted within the required time line. No more than three CAPS per health plan per audit.
Managing multiple priorities, demonstrated by ease and productivity to transition between multiple tasks. Measurement, Department Performance Measure.
Team player, achieved through assisting co-workers with their workload as asked by the Supervisor or peers and be able to have cross-training to fill in when needed.
Basic analytics understanding to track manage and report outcomes of the referral numbers and escalate issues impacting the TAT.
Highly effective communication with members, external constituents, and internal stakeholders.
II. EXCEEDS PERFORMANCE REQUIREMENTS All items listed under “Meets Expectations”, and:
- Problem solving skills demonstrated by identification, recommendation, and implementation of tactics and approaches to improve productivity and team work.
- Taking initiations demonstrated by consistent and active offer participation to be a positive change agent, to problem solve, identify and offer suggestions to improve outcomes in Case Management, and to assist others as needed.
- Leading by example. Be the role model in offering supportive care to patients, and consistently meet needs of the external and internal customers.