Care Manager I – LPN

Jobtailor; Deutschland; Remote; EUR 73.000 - 99.000; Vollzeit

Zusammenfassung

Jobtailor is seeking a Licensed Practical Nurse with expertise in utilization management to lead client-centered care planning and care coordination. The role emphasizes interdisciplinary collaboration and strong documentation to support efficient health plan interactions.

The ideal candidate has 2+ years in utilization management and 3+ years in clinical settings, preferably in case management, plus a nursing degree and CCM certification if possible.

Qualifikationen

• Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) required.
• Two (2) years’ utilization management experience applying evidence-based clinical criteria and benefit plans.
• Three (3) years’ clinical experience, preferably in case management or related area.
• Bachelor’s degree in nursing or a related health services field.
• Certified Case Manager (CCM) certification preferred.
• Tagalog or Ilocano language skills preferred.
• Knowledge of Medicare, Medicaid, and other entitlement programmes.
• Knowledge of HIPAA requirements and PHI privacy and security.

Aufgaben

• Develop and initiate client-centred, comprehensive Individual Care Plans.
• Identify, arrange, and monitor appropriate community services.
• Coordinate and facilitate patient care through assessment, evaluation, planning, implementation, communication, and follow-up.
• Manage discharge plans and collaborate with patients, families, physicians, and nurses.
• Advocate for patients regarding insurance coverage and financial assistance.
• Maintain comprehensive clinical records through detailed, accurate documentation.
• Coordinate interdisciplinary care to support timely access, continuity among providers, and resource optimization.
• Apply care transition principles and coordinate warm hand-offs to appropriate providers/health plans.
• Assist the UM Manager and participate in audits.
• Serve as primary liaison with contracted health plans for case management activities.
• Protect the privacy and security of PHI in line with policies and HIPAA requirements.
• Perform other duties and special projects as assigned.

Kenntnisse

Utilization Management

Case Management

Patient Advocacy

Healthcare Documentation

Interdisciplinary Collaboration

Ausbildung

Bachelor's degree in nursing

Certified Case Manager (CCM)

Jobbeschreibung

• Develop and initiate client-centred, comprehensive Individual Care Plans
• Identify, arrange, and monitor appropriate community services
• Coordinate and facilitate patient care through assessment, evaluation, planning, implementation, communication, and follow-up
• Manage discharge plans and collaborate with patients, families, physicians, and nurses
• Advocate for patients regarding insurance coverage and financial assistance
• Maintain comprehensive clinical records through detailed, accurate documentation
• Coordinate interdisciplinary care to support timely access, continuity among providers, and resource optimization
• Apply care transition principles and coordinate warm hand-offs to appropriate providers and/or health plans
• Assist the UM Manager and participate in internal and external audits
• Serve as primary liaison with contracted health plans for case management activities
• Protect the privacy and security of PHI in line with Medical Group/MSO policies and HIPAA requirements
• Perform other duties and special projects as assigned

Requirements

• Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) required
• Two (2) years’ utilization management experience applying evidence-based clinical criteria and benefit plans required
• Three (3) years’ clinical experience, preferably in case management or a related area, required
• Bachelor’s degree in nursing or a related health services field
• Certified Case Manager (CCM) certification preferred
• Tagalog or Ilocano language skills preferred
• Knowledge of Medicare, Medicaid, and other entitlement programmes
• Knowledge of HIPAA requirements and PHI privacy and security

Core Competencies

Demonstrates expertise in developing and implementing Individual Care Plans, coordinating interdisciplinary patient care, and ensuring compliance with HIPAA and PHI regulations. Proficient in utilization management and case management with a strong focus on patient advocacy and community resource optimization.

Highest-signal resume keywords

• Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN)
• Utilization Management Experience
• Clinical Experience in Case Management
• Certified Case Manager (CCM)
• Knowledge of Medicare and Medicaid

Hard Skills

• Individual Care Plans
• Utilization Management
• Clinical Documentation
• Patient Advocacy
• Care Transition Principles
• Interdisciplinary Care Coordination
• Assessment and Evaluation
• Discharge Planning
• Evidence-Based Clinical Criteria
• Community Resource Optimization

Soft Skills

• Communication
• Collaboration
• Patient-Centered Care
• Problem-Solving
• Advocacy

Certifications & Qualifications

• Certified Case Manager (CCM)

Industry Keywords

• HIPAA Compliance
• PHI Privacy and Security
• Health Plans
• Entitlement Programs
• Clinical Experience