Care Coordinator

4 days ago


Redlands, California, United States Loma Linda University Full time
Job Summary:

The Care Coordinator - LVN is responsible for coordinating patient care across the healthcare continuum, including those with complex medical, socio-economic, and mental health co-morbidities. This role involves utilization management, disease management, complex case management, and inpatient care management in a telephonic and/or onsite care management position.

Key Responsibilities:
  • Reviews inpatient and outpatient services to determine medical appropriateness following evaluation of medical guidelines and benefit determination.
  • Acts as a support to team members, coaching and providing feedback as necessary.
  • Guides patients and families through the healthcare system for transition planning.
  • Participates in on-call rotation after-hours and/or on weekends as needed to meet contractual obligations and provide decision support on managed care issues.
Requirements:
  • Bachelor's Degree preferred.
  • Graduate of a school of Licensed Vocational Nursing (LVN) required.
  • Minimum five years experience in managed care required.
  • Minimum two years ambulatory care management program and/or case management experience required.
Knowledge and Skills:
  • Knowledge of lines of business (LOB) including Commercial, United Health Care, Anthem Blue Cross, Blue Shield of California, Medicare Advantage, ACO.
  • Proficient in application of MCG for both inpatient and ambulatory care.
  • Knowledge of utilization management processes and current standards of care as a foundation for utilization review and transition planning.
  • Knowledge and ability to comply with health plan audits.
  • Ability to interpret CMS including Medicare Managed Care Manual.
  • Able to keyboard 40 wpm.
  • Read; write legibly; speak in English with professional quality; use computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint).
  • Operate/troubleshoot basic office equipment required for the position.
  • Relate and communicate positively, effectively, and professionally with others; work calmly and respond courteously when under pressure; collaborate and accept direction.
  • Bilingual preferred.
  • Communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision.
Licensures and Certifications:
  • Active California Licensed Vocational Nurse (LVN) required.
  • Basic Life Support (BLS) certification from the American Heart Association (AHA) required.
  • Certified Managed Care Nurses from the American Association of Managed Care Nurses within two years of hire.

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