Under the general direction of the RN Case Manager, the CM Coordinator is responsible for facilitating care coordination needs of a defined population.
The LVN CM provides case management support for health education, health coaching, self-management, and transition of care within the defined scope of practice for a licensed vocational or practical nurse.
Associates Degree preferred
Licensure / Certification
Active Unrestricted license as a Vocational (LVN) or Practical nurse (LPN)
1-year managed care experience preferred
Previous case management experience preferred
Core Competencies : Ethics and Values, Customer Focus, Action-Oriented, Learning on the Fly, Manage / Measure Work, Drive for Results, Priority Setting, Timely Decision-Making, Organizing, Functional and Technical Skills
Demonstrated ability to work together across professions and individuals to improve health outcomes.
Computer Proficiency (MS Word, MS Excel, MS Outlook, Video Conferencing)
Capacity to interpret evidenced based guidelines (Interqual and / or Milliman criteria sets), health plan / client specific chronic care guidelines, and policies / procedures
Knowledge of NCQA, DMHC, and state requirements for case management
Essential Functions of Job
Under the general direction of the RN CM, responsible for the execution of care plan interventions for an assigned group of patients.
Responsible for accurate and timely completion of the data collection processes for an assigned group of patients.
Responsible for providing evidenced-based self-management strategies, health coaching, and health education to the assigned population.
Responsible for updating the care plan based on care coordination activities for members open to case management.
Conducts ongoing follow-up with the individual, family and / or family caregiver in the evaluation of care coordination activities
Responsible for adherence to the policies and procedures for the Contact Center; to include, but not limited to, managing the outbound call queue to collect data for health risk assessments, coordinate care for care gap closures, or specialty referral tracking.
Responsible for transition of care outreach, coordination, and information exchange per policies and procedures.
Ensures compliance with desktop procedures for appropriate documentation