Medical Case Manager (LVN)

Temporary Medical Case Manager (LVN) CalAIM

Location: Orange County, CA



Job Type: Temporary / Contract



Assignment Duration: Up to 6 months



Schedule: Monday Friday, 8:00 AM 5:00 PM



Work Arrangement: Fully Onsite

About the Role

We are seeking an experienced Licensed Vocational Nurse (LVN) to join our CalAIM team as a Temporary Medical Case Manager . This position supports care coordination and utilization management activities for CalAIM services, ensuring requests are reviewed appropriately and members receive timely, high-quality support.

The ideal candidate will have strong clinical judgment, excellent communication skills, and the ability to work independently in a fast-paced healthcare environment. Experience with managed care or authorization review is highly preferred.

Key Responsibilities

• Review authorization requests for CalAIM services for medical appropriateness using established clinical criteria, policies, and procedures.

• Verify and process CalAIM referrals received through healthcare systems, telephone, and fax.

• Apply established clinical protocols to determine medical necessity.

• Coordinate member care with health networks, healthcare providers, internal teams, patients, and families.

• Accurately document authorization decisions, clinical information, and updates in utilization management or care management systems.

• Determine the appropriate action for requested services, including approval, modification, or denial.

• Refer cases to the Medical Director for review when appropriate.

• Contact members, families, and CalAIM providers to obtain additional information as needed.

• Support department goals and priorities while maintaining a member-focused, mission-driven approach.

• Meet established productivity, quality, documentation, and performance standards.

• Collaborate effectively with internal departments and external healthcare partners.

• Perform other duties and projects as assigned.

Required Qualifications

• Current, unrestricted California LVN license required.

• High school diploma or equivalent.

• At least 3 years of nursing experience.

• Strong clinical judgment and problem-solving skills.

• Excellent verbal and written communication abilities.

• Ability to work independently and manage multiple priorities.

• Proficiency with Microsoft Office applications, including Word, Outlook, Excel, and PowerPoint.

• Ability to work effectively in a fast-paced environment.

Preferred Qualifications

• Experience in managed care .

• At least 1 year of authorization review experience .

• Experience with utilization management, care management, or medical necessity review.

• Bilingual in English and one of the following threshold languages: Arabic, Farsi, Chinese, Korean, Spanish, or Vietnamese .