LVN or RN Case Manager

Phoenix Virtual Solutions; Makati; On-site; PHP 360,000 - 600,000; Full time

Job summary

Phoenix Virtual Solutions is seeking an RN/LVN Case Manager to assess, plan, implement, and monitor patient care plans. You will collaborate with physicians and the health care team to develop realistic goals and coordinate services across the care continuum.

The role requires strong communication, HIPAA adherence, and proficiency with common EHR systems to manage documentation and reporting for a diverse caseload in a patient-focused environment.

Qualifications

• RN or LVN licensure required with current Philippines credentials.
• Familiarity with case management policies and procedures.
• Knowledge of managed care philosophy and HMO guidelines.
• Detail-oriented with strong written and verbal communication.

Responsibilities

• Assess, plan, implement, monitor and evaluate patient care options.
• Develop care plans with short- and long-term goals and barriers.
• Ensure accurate documentation and quarterly plan evaluations.
• Communicate openly with patients, families and care team.
• Coordinate with managed care plans, physicians and facilities.

Skills

HIPAA compliance

Care coordination

Strong communication

Microsoft Office

Interdisciplinary collaboration

Education

RN/LVN licensure

Tools

EHR systems

Job description

About the role

Under the direct supervision of the Manager, Case Management, the RN/LVN Case Manager is responsible for assessing, planning, implementing, monitoring, and evaluating options and services to develop a patient-focused action plan for patients. He/she collaborates with the primary physician and other health care team members in the development of the patient goals and action, ensuring the formulation of a realistic and definitive goal that represents the total care needs and resources of the patient and family. He/she facilitates the patient's progression through the care continuum and effects appropriate changes in collaboration with the health care team, the patient, and community resources, assessing for critical factors necessary to determine the patient's health, functional status, and psychosocial well-being, while maintaining patient satisfaction and management of cost-effective quality interventions.

Key responsibilities

• Respect the dignity, confidentiality, and privacy of each patient and adhere to HIPAA regulations and policies in relation to confidentiality of patient information

• Perform medical, functional, safety, nutritional, and psychosocial assessments on targeted assigned caseloads to evaluate the member's needs and coordinate appropriate care

• Maintain documentation in a care plan which defines the issues, problems, and appropriate interventions and includes follow-up evaluations, with quarterly treatment plan evaluations and concurrent monitoring

• Develop case management plans with short- and long-term goals, identifying barriers to meeting goals or complying with the plan

• Provide open, sensitive, timely communication with patients, families, and their significant others to participate in the patient's care

• Maintain effective communication with managed care plans, physicians, hospitals, extended care facilities, members, and co-workers concerning the referral process

• Coordinate and complete special projects as delegated by the Manager of Case Management

• Participate in the Interdisciplinary Care Team (ICT) Meeting as they relate to target cases

• Assist in coordinating services for high cost/high utilization cases to minimize inpatient utilization

• Assist with orientation and training for new employees as needed

About you

• RN/LVN licensure required

• Must be familiar with Case Management Policies and Procedures and its function

• Must understand the managed care philosophy, including advanced knowledge of HMO policies and procedures and the managed care industry

• Must be detail-oriented and possess strong communication skills, both verbal and written

• Must be computer literate in Microsoft Office programs necessary for word processing or report generation

• Familiarity with medical guidelines such as McKesson InterQual, Milliman Care Guidelines, Apollo Medical Review Criteria, and Health Plan established guidelines

• Ability to manage diverse areas of understanding and interface effectively with all employees, members, employers, and providers

• Social work experience to coordinate care and services for targeted caseload