CalOptima Health is seeking a highly motivated an experienced TEMPORARY - Medical Case Manager - LVN to join our team.  The Medical Case Manager LVN for Notice of Action (NOA) is responsible for providing NOA coordination for CalOptima Health’s Utilization Management clinical determinations. The incumbent will facilitate communication and coordination among all participants involved in the NOA process to promote quality and cost-effective outcomes. The incumbent will provide intensive coordination in a process that includes assessment, planning, facilitation, implementation, coordination, monitoring and evaluation of the NOA process. 

Position Information:

• Department: UM - Prior Authorization


• Work Arrangement: Full Office 


• Work Schedule: Thursday to Monday (8:00 a.m. to 5:00 p.m.) 

Submission Information:

• The deadline to be guaranteed full review of your submission is due by Tuesday, February 11, 2025 by 9:00 p.m. PST.  This position will remain open for a minimum of seven (7) days, but may be extended if a lack of qualified applicants are received or if we are hiring multiple positions.

Duties & Responsibilities:

• 85% - Program Support




• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.


• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.


• Performs comprehensive assessment of all identified NOAs which includes but is not limited to assessment of the reason for the NOA, coordination with physician reviewers and NOA production and compliance.


• Develops and implements member specific NOA letters.


• Communicates with CalOptima Health's physician reviewers, members’ physicians, specialists, community agencies and vendors to ensure accurate and complete clinical information is presented.


• Follows CalOptima Health’s protocol for documentation.


• Works collaboratively with interdepartmental staff for NOA resolution.


• Identifies cases needing review or input from a manager, director or Medical Director and routes accordingly.


• Processes NOAs with the highest degree of nursing judgment and accuracy.


• Closes cases according to defined case closure procedure in a timely manner and in accordance with established guidelines.


• Prepares and maintains appropriate documentation of patient care and progress within the care plan.


• Acts as an advocate in the client’s best interest for necessary funding, treatment alternatives, timelines, coordination of care and frequent evaluations of progress and goals. 




• 10% - Administrative Support




• Develops desktop procedures, assessments and referral templates to facilitate the implementation and compliance with new case management programs or requirements.




• 5% - Completes other projects and duties as assigned. 

Minimum Qualifications:

• High school diploma or equivalent required.


• 3 years of clinical experience required, 1 year of which must be as a UM Clinical Nurse Reviewer or NOA processor.


• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

Preferred Qualifications:

• 3 years of managed care experience.

Required Licensure / Certifications:

• Current, unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California required.

Knowledge & Abilities:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.  


• Work independently and exercise sound judgment.


• Communicate clearly and concisely, both orally and in writing.


• Work a flexible schedule; available to participate in evening and weekend events.


• Organize, be analytical, problem-solve and possess project management skills.


• Work in a fast-paced environment and in an efficient manner.


• Manage multiple projects and identify opportunities for internal and external collaboration.


• Motivate and lead multi-program teams and external committees/coalitions.


• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.


• Ability to speak (enunciate) clearly in conversation and general communication.


• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.


• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.


• Lifting and moving objects, patients and/or equipment less than 10 pounds