Case Management Coordinator - LVN/LPN II

• Pursues effective relationships with others by sharing resources, information, and knowledge with coworkers and members. Listens to, addresses, and seeks performance feedback. Pursues self-development; acknowledges strengths and weaknesses based on career goals and takes appropriate development action to leverage / improve them. Adapts to and learns from change, challenges, and  feedback; demonstrates flexibility in approaches to work. Assesses and responds to the needs of others to support a business outcome.
• Completes work assignments by applying up-to-date knowledge in subject area to meet deadlines; follows procedures and policies, and applies data and resources to support projects or initiatives with limited guidance and/or sponsorship. Collaborates with others to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports the completion of priorities, deadlines, and expectations. Identifies and speaks up for ways to address improvement opportunities.
• Assists in providing services related to the initial case assessment by\: coordinating with patients and their families to evaluate needs, goals, and current services with day-to-day supervision; determining initial eligibility, benefits, and education for all admissions with day-to-day supervision; entering authorization data (e.g., authorization data regarding admitting/principle diagnoses, bed type(s), and disposition data for accuracy, after visit summary) with general guidance; supporting others in exploring options to assure that quality, cost-efficient care is provided; and leveraging working knowledge to assess medical necessity for hospital admission and required level of care to inform physicians.
• Assists in monitoring and evaluating plan of care by\: coordinating resources and services to assure continuity and quality of care; supporting the review and updating of authorizations, attending case management rounds with clinicians, and reviewing diagnoses as needed; contacting patients periodically to assess progress toward treatment milestones and care plan goals with day-to-day supervision; assisting with identifying barriers to achieving goals and ensuring that they are discussed with the patient and care team thoroughly; assisting with verifying that all services remain consistent with established guidelines and standards; and documenting/updating the patients case in all medical files with minimal guidance.
• Assists in providing services related to the case-planning process by\: partnering in the development of a client-focused case management plan with treatment goals based on the patients and familys/caregivers needs under limited guidance; collaborating with health-care team, patient, and caregivers to assure plan of care is safe, agreeable, and appropriate with guidance; and validating that the plan is consistent with regulatory, accreditation, and regional guidelines with some guidance.
• Supports efforts to remain updated on current research, policies, and procedures by\: coordinating with others to attend seminars, workshops, and approved educational programs and workshops specific to professional needs; contributing to the implementation of systems, processes, and methods to maintain team knowledge of community resources, with some guidance; analyzing operational team data and key metrics applied to own work with limited guidance; making suggestions for change or improvement as needed with minimal guidance; and learning about and adhering to policies and regulations impacting the teams work with minimal guidance.
• Assists in services related to patient disposition by\: assisting in identifying patients ready for disposition planning activities under guidance; beginning to develop, evaluate, coordinate, and communicate a comprehensive disposition plan in collaboration with the patient, family, physician, nurses, social services, and other healthcare providers and agencies; and obtaining authorizations/approvals as needed for services for the patient with day-to-day supervision.
• Assists in connecting patients with existing services by\: supporting patients with gaining access to care based on their needs and integrating or referring them into existing programs/services with minimal guidance; referring patients to outside entities, ambulatory case managers, care managers, social workers, and/or internal/external resources as appropriate with guidance; and gathering and summarizing information for making location-specific adaptations as necessary.
• Assists others in serving as liaison between internal and external care by\: reviewing benefits/services available based on regulations or specific coverage to patients, families, and other members of the community, and assisting with problem solving identified concerns with general supervision; providing case management to a limited caseload of low-risk patients referred to external facilities/agencies with general supervision; learning and applying standard strategies and concepts to propose recommendations in interdisciplinary team meetings with internal and/or external stakeholders with guidance; and leveraging working knowledge of the patients case to act as a resource for physicians, health plan administrators, and contracted vendors.

• Pursues effective relationships with others by sharing resources, information, and knowledge with coworkers and members. Listens to, addresses, and seeks performance feedback. Pursues self-development; acknowledges strengths and weaknesses based on career goals and takes appropriate development action to leverage / improve them. Adapts to and learns from change, challenges, and  feedback; demonstrates flexibility in approaches to work. Assesses and responds to the needs of others to support a business outcome.
• Completes work assignments by applying up-to-date knowledge in subject area to meet deadlines; follows procedures and policies, and applies data and resources to support projects or initiatives with limited guidance and/or sponsorship. Collaborates with others to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports the completion of priorities, deadlines, and expectations. Identifies and speaks up for ways to address improvement opportunities.
• Assists in providing services related to the initial case assessment by\: coordinating with patients and their families to evaluate needs, goals, and current services with day-to-day supervision; determining initial eligibility, benefits, and education for all admissions with day-to-day supervision; entering authorization data (e.g., authorization data regarding admitting/principle diagnoses, bed type(s), and disposition data for accuracy, after visit summary) with general guidance; supporting others in exploring options to assure that quality, cost-efficient care is provided; and leveraging working knowledge to assess medical necessity for hospital admission and required level of care to inform physicians.
• Assists in monitoring and evaluating plan of care by\: coordinating resources and services to assure continuity and quality of care; supporting the review and updating of authorizations, attending case management rounds with clinicians, and reviewing diagnoses as needed; contacting patients periodically to assess progress toward treatment milestones and care plan goals with day-to-day supervision; assisting with identifying barriers to achieving goals and ensuring that they are discussed with the patient and care team thoroughly; assisting with verifying that all services remain consistent with established guidelines and standards; and documenting/updating the patients case in all medical files with minimal guidance.
• Assists in providing services related to the case-planning process by\: partnering in the development of a client-focused case management plan with treatment goals based on the patients and familys/caregivers needs under limited guidance; collaborating with health-care team, patient, and caregivers to assure plan of care is safe, agreeable, and appropriate with guidance; and validating that the plan is consistent with regulatory, accreditation, and regional guidelines with some guidance.
• Supports efforts to remain updated on current research, policies, and procedures by\: coordinating with others to attend seminars, workshops, and approved educational programs and workshops specific to professional needs; contributing to the implementation of systems, processes, and methods to maintain team knowledge of community resources, with some guidance; analyzing operational team data and key metrics applied to own work with limited guidance; making suggestions for change or improvement as needed with minimal guidance; and learning about and adhering to policies and regulations impacting the teams work with minimal guidance.
• Assists in services related to patient disposition by\: assisting in identifying patients ready for disposition planning activities under guidance; beginning to develop, evaluate, coordinate, and communicate a comprehensive disposition plan in collaboration with the patient, family, physician, nurses, social services, and other healthcare providers and agencies; and obtaining authorizations/approvals as needed for services for the patient with day-to-day supervision.
• Assists in connecting patients with existing services by\: supporting patients with gaining access to care based on their needs and integrating or referring them into existing programs/services with minimal guidance; referring patients to outside entities, ambulatory case managers, care managers, social workers, and/or internal/external resources as appropriate with guidance; and gathering and summarizing information for making location-specific adaptations as necessary.
• Assists others in serving as liaison between internal and external care by\: reviewing benefits/services available based on regulations or specific coverage to patients, families, and other members of the community, and assisting with problem solving identified concerns with general supervision; providing case management to a limited caseload of low-risk patients referred to external facilities/agencies with general supervision; learning and applying standard strategies and concepts to propose recommendations in interdisciplinary team meetings with internal and/or external stakeholders with guidance; and leveraging working knowledge of the patients case to act as a resource for physicians, health plan administrators, and contracted vendors.

• Bachelors degree in Nursing or related field OR Minimum three (3) years of experience in case management or a directly related field.

• Vocational Nurse License (California) required at hire
   

• Knowledge, Skills, and Abilities (KSAs)\: Integrity; Teamwork; Dependability; Written Communication; Acts with Compassion; Member Service; Relationship Building; Managing Diverse Relationships; Maintain Files and Records; Business Relationship Management; Company Representation
• Bilingual (English/Spanish) Level II required.

• Bachelors degree in Nursing or related field OR Minimum three (3) years of experience in case management or a directly related field.

• Vocational Nurse License (California) required at hire
   

• Knowledge, Skills, and Abilities (KSAs)\: Integrity; Teamwork; Dependability; Written Communication; Acts with Compassion; Member Service; Relationship Building; Managing Diverse Relationships; Maintain Files and Records; Business Relationship Management; Company Representation
• Bilingual (English/Spanish) Level II required.

• Registered Nurse License (in the state where care is provided).

Notes\:

• Must successfully pass or have passed the bilingual test (within the last 12 months), or be active in the QBS program.

• Registered Nurse License (in the state where care is provided).

Notes\:

• Must successfully pass or have passed the bilingual test (within the last 12 months), or be active in the QBS program.

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