Job Description

JOB SUMMARY:

The Concurrent Case Management LVN is responsible for supporting inpatient and post-acute care coordination and concurrent review activities to ensure medically appropriate, timely, and cost-effective utilization of healthcare services for members of a California Managed Services Organization (MSO).

Under the direction of the Inpatient/Post-Acute Manager and RN leadership, the Concurrent Case Management LVN performs concurrent review, monitors inpatient and post-acute utilization, supports discharge planning, facilitates transitions of care, and coordinates services across the continuum of care. This role collaborates closely with hospitals, skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term acute care hospitals (LTACHs), home health agencies, physicians, and interdisciplinary care teams.

The Concurrent Case Management LVN supports organizational goals related to quality outcomes, appropriate utilization, reduced readmissions, regulatory compliance, and continuity of care for Medicare Advantage, Medi-Cal, Commercial, and other managed care populations.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS:

Education/Training

Minimum: High School diploma or equivalent required. Graduation from an accredited vocational nursing program.

Preferred: Additional training or coursework in case management, utilization management, or care coordination.

Experience

Minimum: At least two years of clinical experience as an LVN.

Preferred: Experience in concurrent review or inpatient utilization management. Experience working in a Managed Services Organization (MSO), IPA, or health plan. Experience with Medicare Advantage and Medi-Cal managed care populations. Experience using electronic medical records and care management systems. Experience coordinating post-acute services.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Certification(s)

Current California Licensed Vocational Nurse (LVN) license in good standing and Basic Life Support (BLS) certification.

Skills, Knowledge & Abilities

• Knowledge of inpatient and post-acute care coordination processes
• Understanding of utilization management and medical necessity principles
• Knowledge of SNF, IRF, LTACH, home health, and hospice care settings
• Ability to monitor patient progress and identify barriers to discharge
• Strong clinical documentation and organizational skills
• Ability to work independently and collaboratively
• Strong communication and interpersonal skills
• Ability to manage multiple cases simultaneously
• Proficiency with electronic medical record and care management systems
• Knowledge of managed care and healthcare delivery systems in California
• Understanding of HIPAA and patient confidentiality requirements

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical demands described here are represented of those that must be met by an employee to successfully perform the essential functions of this job. Work is primarily performed in an office, hospital, and/or community-based setting; may require standing/walking for extended periods during onsite rounds or facility visits. Frequent use of computer, phone, and video conferencing; prolonged sitting when performing documentation and reporting. Ability to travel locally to hospitals and post-acute facilities; occasional regional travel may be required. Ability to lift/move items up to approximately 20 pounds (e.g., laptop, files, work materials). Visual and auditory acuity required to review clinical documentation and communicate effectively with patients, families, and care teams.

PAY RANGE

$35.00 - $40.00 / hourly