Case Manager (LVN)

Essential Job Outcomes Section II of the CAT. Specific job related responsibilities and duties. Supports Case Management (CM) activities and programs both at Shared Services and in Provider clinics based on patients with MCMF''s Managed Care and ACO populations. Identifies and evaluates members for enrollment into one of the Memorial Care Medical Foundation Case Management programs (Complex, Care Coordination, Transplant etc.) through physician referral, utilization data, inpatient referral, predictive modeling software, health plan referral, patient and family referral, and other sources as they occur. Carries caseload mix as set by department manager to align with overall equity, acuity and organization goals. Assesses, plans, implements, coordinates, monitors, and evaluates all options and services with the goal of optimizing and supporting the member''s health status and goals. Adheres to CM Standards of Practice and uses evidence-based clinical treatment guidelines, preventive guidelines, protocols, and other metrics in the development of Care Plans and Shared Action Plans. Monitors outcomes of the plan that are adherent to all regulatory requirements and are patient-centered, promoting efficiency and quality in the delivery of healthcare for the designated patient population. Modifies the care plan based on patient needs/stated goals and per department''s productivity standards and quality measures. Integrates evidence-based clinical treatment guidelines, preventive guidelines, protocols, and other metrics in the development of Care Plans and Shared Action Plans. Develops care plans and monitors outcomes of the plan that are adherent to regulatory requirements and are patient-centered, promoting efficiency and quality in the delivery of healthcare for the designated patient population. Modifies the care plan based on patient needs/stated goals and per department''s productivity standards and quality measures. Submit all Care Plans to the RN for sign off. Works effectively with other members of the health care team and acts as liaison to optimize interventions. Coordinates services with appropriate physicians, facilities, contracted providers, and ancillary providers (disease management, behavioral health, social services and community resources) as indicated. Dedicated to the delivery of high-quality patient care and service, has a continuous learning approach to work, and finds opportunity in challenges and barriers. Maintains comprehensive and confidential patient records in compliance with all HIPAA regulations and per documentation standards with the patient''s electronic medical record or other approved documentation system. Supports the organization''s goals and mission statement and in a professional manner. Attends and participates in appropriate Patient Care Conferences, committees or related meetings, providing comprehensive and accurate case management reports and documents as required. Supports the organization''s goals and mission statement and in a professional manner. ''Other duties as assigned'' Experience List the minimum experience, skills, knowledge and abilities required to do the job. Previous Case Management experience in a managed care or hospital setting preferred Experience applying evidence-based guidelines and criteria (i.e.: MCG, InterQual, CMS); Health plan medical policy / clinical coverage guidelines required Work experience in an Electronic Medical Record, Microsoft Word, Microsoft Excel and Microsoft Outlook required A minimum of two (2) years'' Clinical Nursing Experience in a hospital or like setting required Knowledge of CMS (Centers for Medicare and Medicaid Services) coverage policies required Education List the education licensures or certifications preferred or required to do the job. Current California Registered Nurse license (RN), Licensed Vocational Nurse (LVN) Associate degree (AA) in nursing or equivalent from a two-year college or technical school required Bachelor of Science or Master''s degree in Nursing or related field preferred CCM preferred

Created: 2026-04-04