RN/LVN Case Manager

Job Description

RN/LVN CASE MANAGER

HealthSmart MSO is currently seeking strong Case Manager(s) to provide ongoing and intensive case management services for managed care members. The Case Manager facilitates communication and coordination among all participants of the health care team and the member to ensure that the services are provided to promote quality cost-effective outcomes which includes assessment, planning, facilitation, implementation, coordination, monitoring and evaluation of our member’s needs.

Experience & Education:

1. Registered Nurse or Licensed Vocational Nurse with a current unrestricted CA professional license.

2. Minimum 5 years clinical experience, managed care experience preferred.

3. Experience with developing Care Plans and participating in Interdisciplinary Team Meetings.

4. CCM certificate preferred.

5. Bilingual skills in either English/Spanish or English/Vietnamese highly desirable.

Accountability/Duties/Responsibilities:

Maintain compliance with CM Program, UM Plan and Policies and Procedures as related to the role of RN/LVN Case Manager.

Organize daily Case Management activity for IPAs/Medical Groups, by using a multi-disciplinary approach to coordinating care with Hospital Case Managers, Health Plans, Primary Care Physicians, Medical Director, Hospitalists, and other members of the healthcare team.

Focus on coordination of care across settings or transitions in care including inpatient acute and nursing facilities, and outpatient residential, surgery center, home care, and nursing facilities or other sites where care may be rendered.

Evaluate already available data, for example, lab results, claims, pharmacy, medical record, discharge planning and sentinel event data, to determine areas where there is lack of continuity and coordination of care.

Assist members and providers to locate and arrange appointments with providers/specialists.

Provide added support for the member and provider in cases where coordination of care is complicated.

Monitor hospital, skilled nursing, home health, durable medical equipment, ambulatory care and other continuity of care services to ensure that members are receiving the most appropriate level of care for their health care needs.

Assist the Customer Service Department in service coordination whenever the members have questions about their benefits or problems with accessing any health care benefits.

Assist members in coordinating services such as medically necessary transportation, standing referrals, continuity of care for new enrollees and enrollees with terminated providers, access to difficult to locate specialty care and referrals to community resources.

Serve as a liaison between the Member and local agencies to obtain services or care that are not covered benefits to ensure Members receive care or treatment when medically indicated and not available to them through their insurance.

WORK ENVIRONMENT, PHYSICAL DEMANDS AND MENTAL DEMANDS:

1. Typical office environment with no unusual hazards.

2. Repetitive movements with use of keyboard, mouse, and phone.

3. Constant sitting while using the computer terminal.

4. Constant use of sight abilities while reviewing documents.

5. Regularly speak and listen in person, telephone, and remote meetings

6. Constant mental alertness must possess planning/organizing skills and must be able to work under deadlines.

7. Occasionally required to stand, walk, stoop, kneel, bend, crouch and lift up to but not more than 10 pounds.

HealthSmart provides a full suite of benefits:

1. Generous contribution toward individual and dependent Medical and Dental Insurances.

2. Vision Insurance

3. Short Term Disability Gap Insurance

4. Long Term Disability Insurance

5. Group Life Insurance with buy up option and coverage available for spouses and children

6. Flexible Spending Account

7. Generous Paid Time Off program

8. Paid Holidays

9. 401k with matching contribution

10. Remote/Hybrid work arrangements

11. Discretionary Bonuses

Salary is dependent upon type of licensure and experience.

Company Description

HealthSmart MSO, Inc. (HSMSO) is a management service organization serving the needs of providers in a managed care setting. Our Vision is to motivate, facilitate, and create opportunities for our client’s and team. HealthSmart MSO’s goal is to ensure its Managed IPA’s, Medical Groups, Hospitals and Physician Practices have a coordinated cost effective delivery system where quality services to members and physicians are achieved. Together, members and providers work toward a common goal of wellness and preventive medicine. As needs arise, physicians and their members feel comfortable knowing that they will receive care from the most dedicated and friendly managed care team.

Full-time