LVN Outpatient Utilization Review

LVN Outpatient Utilization Review - River City Medical Group

Shift- Monday-Friday day shift

Description:

The Clinical Case Manager coordinates all systems/services needed for an organized, multidisciplinary, patient centered team approach, and cost-effective care for Managed Medi-cal patients. The Clinical Case Manager follows and manages the course of treatment for patients while coordinating care with physicians, nurses, case managers

Contract to Hire: This position is starting out as a 6 month contract to hire position with River City Medical Group. Once completed, River City will be looking to hire on the employee directly

Job Duties:

• The Case Manager is responsible for managing a continuum of care from admission through discharge for assigned patients. The Case Manager partners with medical staff, utilizes scientific evidence for best practices, relevant data and compliance with the mission/philosophy, standards, goals and core values. 
• Proactively assesses all potential case management and CCS member cases identified from either external or internal sources and actively manages all high risk, high volume cases throughout the continuum of the member’s health care needs or until they reach a maintenance mode.
• Demonstrates a multidisciplinary approach in identifying problems, communication and negotiating with the member’s PCP, family members, caregivers, other members of the health care team, community resources and the Health Plans.
• Participate in the development of patient focused long/short term goals, implementing, evaluating and modifying the care plan.
• Researches and refers members to sources for alternative funding, community services and other services which may provide support to the patient and family.
• Tracks all CCS referrals for timely notification of decisions. Assists Medical Director with CCS appeals.

Qualifications:

• CA LVN License
• At least 1 year of LVN experiences in a SNF or acute care setting

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