LVN Case Manager: Care Coordination & Advocacy

Cambridge Healthcare Services, LLC; Laguna Hills (CA); On-site; USD 85,000 - 125,000; Full time

Job summary

Cambridge Healthcare Services, LLC in Laguna Hills, CA seeks a dedicated Case Manager to coordinate delivery of services for managed care and Medicare residents, ensuring compliance with current standards and regulations. The role monitors cost effectiveness, manages admissions and discharges, advocates for residents and families, and liaises with insurers and medical management professionals.

Excellent communication and teamwork are essential.

Qualifications

• Minimum of 1 year case management experience in skilled nursing facility preferred
• Must have 5 or more years as a licensed nurse
• Excellent verbal and written skills
• Knowledge of Point Click Care helpful

Responsibilities

• Managing all types of insurance cases from admission through discharge
• Following up with residents’ post-discharge follow up
• Communicating by phone or in writing the resident’s status and changes in care plan to payer
• Documenting all payer interactions regarding resident progress and expected outcomes
• Maximizing benefits by coordination of cost effective care
• Meeting with facility interdisciplinary team to coordinate services and ensure total regimen of resident care is achieved
• Frequently speaking with business office and collaborating with other departments to ensure accurate census and payment of residents
• Daily review of medical records to confirm compliance with medical necessity
• Planning and organizing time and duties to efficiently maintain caseload
• Protecting each residents file and data with confidentially per HIPAA standards

Skills

Case management

Nursing background

Verbal communication

Written communication

Education

Completion of nursing training from accredited school

Valid nursing license

Valid CPR and BLS card

Tools

Point Click Care

Job description

Cambridge Healthcare Services, LLC in Laguna Hills, CA seeks a dedicated Case Manager to coordinate delivery of services for managed care and Medicare residents, ensuring compliance with current standards and regulations. The role monitors cost effectiveness, manages admissions and discharges, advocates for residents and families, and liaises with insurers and medical management professionals.

Excellent communication and teamwork are essential.