CASE MANAGER (LPN/LVN)- Full Time

Riverside Medical Clinic

Identifies, plans, and coordinates high-risk patient care (frail, chronic disease, catastrophic injury) in an ambulatory setting. Reviews referrals and applies the UM standards for patient care. Ensures continuity of care across the continuum. Promotes and evaluates quality and cost-effective outcomes.

Qualifications:

• High School Diploma or GED required.
• Graduate of an accredited LVN Program.
• A.A., Diploma preferred.
• One to two years related experience and/or training; or equivalent combination of education and experience.

Current California LVN license.

Essential Functions:

• Assess available information to determine patient needs. Develop and initiate comprehensive, multidisciplinary treatment plans.
• Consult and coordinate treatment plans with providers.
• Establish and implement with patient and health care team measurable goals within the proposed treatment plan.
• Verify patient and medical group eligibility and benefits. Monitor utilization of resources and readjust treatment plans when appropriate.
• Monitor patient responses to treatment plans.
• Monitor patient outcomes to determine patient satisfaction as well as the effectiveness and efficiency of the treatment plans.
• Orient providers to managed care and RMC goals and philosophies.
• Initiate required QRM reports per company policy.
• Utilize established criteria for authorization guidelines.
• Communicate problems with patients and physicians to resolve issues in a timely manner.