Complex Case Manager; LVN

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  • 19-00160
  • Full Time/Contract
  • Case Management
  • Fountain Valley, CA
Job Description
Complex Care Manager Coordinator (LVN)


  • Supports Case Management (CM) activities and programs both at Shared Services and in Provider clinics based on patients with Managed Care and ACO populations.
  • Identifies and evaluates members for enrollment into one of the Case Management Programs (SPARK/IOCP, Complex, Care Coordination) through physician referral, utilization data, inpatient referral, predictive modeling software, health plan referral, patient and family referral, and other sources as they occur.
  • Carries caseload mix as set by department manager to align with overall equity, acuity and organization goals.
  • Assesses, plans, implements, coordinates, monitors, and evaluates all options and services with the goal of optimizing and supporting the member's health status and goals.
  • Adheres to CM Standards of Practice and uses evidence-based clinical treatment guidelines, preventive guidelines, protocols, and other metrics in the development of Care Plans and Shared Action Plans.
  • Monitors outcomes of the plan that are adherent to all regulatory requirements and are patient-centered, promoting efficiency and quality in the delivery of healthcare for the designated patient population. Modifies the care plan based on patient needs/stated goals and per department's productivity standards and quality measures.
  • Works effectively with other members of the health care team and acts as liaison to optimize interventions.
  • Coordinates services with appropriate physicians, facilities, contracted providers, and ancillary providers (disease management, behavioral health, social services and community resources) as indicated.
  • Dedicated to the delivery of high-quality patient care and service, has a continuous learning approach to work, and finds opportunity in challenges and barriers.
  • Maintains comprehensive and confidential patient records in compliance with all HIPAA regulations and per documentation standards with the patient's electronic medical record or other approved documentation system.
  • Attends and participates in appropriate Patient Care Conferences, committees or related meetings, providing comprehensive and accurate case management reports and documents as required.
  • Supports the organization's goals and mission statement and in a professional manner.
  • Maintains and complies with all policy and procedures.
  • Performs additional duties/tasks as assigned by the Supervisor and/or Manager.


  • Previous Case Management experience
  • Previous and or ability to learn use of electronic medical record, UM/CM platforms or electronic health record preferred.
  • Knowledge of CMS (Centers for Medicare and Medicaid Services) coverage policies required.
  • Work experience in Microsoft Word, Microsoft Excel and Microsoft Outlook.
  • Work experience applying evidence-based criteria (i.e.: MCG, InterQual); Health plan medical policy / clinical coverage guidelines.
  • Clinical Nursing Experience in a hospital or like setting (2 years min)
  • Current California Registered Nurse license (RN), Licensed Vocational Nurse (LVN) or MSW/LCSW
  • Associate degree (AA) in nursing or equivalent from a two-year college or technical school.
  • Bachelor of Science in Nursing or equivalent preferred.
  • CCM preferred.


  • $34/hr – $36/hr

Additional Information

  • Full Time, M-F
  • 8:00 am – 5:00 pm


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