Care Manager LVN
Major Functions (Duties and Responsibilities)
1. Responsible for serving as a resource for Members and Providers for care management and care coordination.
2. Responsible for screening Members for appropriate care management needs, documenting findings and communicating the findings to the RN Care Manager.
a. LVN Care Manager uses approved screening tools which contribute to the assessment (i.e. Health Risk Assessment or other designed tool)
3. Contributing to the development and modification of the Individualized Care Plan (ICP) including:
a. Reviewing ICP recommendations with RN Care Manager Team Member and other Interdisciplinary Care Team (ICT) members as appropriate
b. Educating Members according to approved plan and material content
c. Communicating unexpected results with RN Care Manager Team Member and other ICT members as appropriate.
4. Acts as a Member advocate at all times
5. Serves as a liaison between Members, caregivers and all members of the ICT
6. Assist and facilitate referrals for Members that are eligible for carve-out programs such as CCS, multi-organ transplant, etc.
7. Assist members with immediate needs with regard to access, referrals and authorizations.
8. Facilitates referrals to resources such as LTSS, Independent Living and Diversity Services, Behavioral Health, and community resources.
9. Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community.
10. Responsible for promoting a collaborative and effective working environment within the Team by engaging in evidenced-based communication strategies (such as Motivational Interviewing) when discussing responsibility/sharing of tasks, effectively resolving conflicts as they arise, and collaborating on Member case discussions.
11. Responsible for building and maintaining a positive working relationship with Providers, including, but not limited to, communication via in-person, over the phone, and through digital means such as email and fax.
12. Responsible for engaging with Members, both in-person and on the phone, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promotes collaboration between the Member and his or her medical/behavioral team, as well as to increase the Member’s sense of control over their whole health.
13. Model commitment to continuous quality improvement by engaging in quality improvement initiatives and projects, such as by identifying and addressing HEDIS gaps, and by identifying, developing, and testing new practices for improving Member health outcomes.
14. Assists with the coordination of medical and behavioral health access issues with PCP offices, specialists, and ancillary services.
15. Responsible for any other duties as required to ensure successful care management processes and Member outcomes.
16. Under the direction of designated supervisor or request from a licensed Team Member (i.e. RN Care Manager), other duties as required to ensure Health Plan operations are successful.
Three (3) or more years of care management experience in a health care delivery setting.
Minimum 1 year clinical experience in an acute care facility or skilled nursing facility.
Clinical experience in home health or clinic setting preferred.
Experience in an HMO or experience in Managed Care setting preferred.
Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California BRN