LVN Case Manager: Utilization & Care Coordination

BAKERSFIELD FAMILY MEDICAL GROUP, INC.; Bakersfield (CA); On-site; USD 42,000 - 49,000; Full time

Job summary

Bakersfield Family Medical Group, Inc. is looking for an LVN Case Manager to review referrals for ambulatory and inpatient services, aligning with health plan criteria and CMS guidelines.

You will collaborate with the Medical Director and Utilization Management leadership, ensuring timely decisions and maintaining confidentiality. The role requires an LVN license, 3 years acute hospital experience, and experience in case management is recommended.

Qualifications

• Graduate from an accredited school of Nursing.
• Valid State License as an LVN.
• Three years acute hospital experience, required.
• Case Management experience, recommended.

Responsibilities

• Review referrals for ambulatory care, elective inpatient services, and durable medical equipment using established criteria and Health Plan guidelines.
• Serve as clinical liaison for Utilization Management with Medical Director and UM Leadership.
• Maintain patient safety and HIPAA guidelines.
• Identify problems in the UM process and provide solutions.
• Collaborate with Physician Relations for Letters of Agreement when referrals are approved to non-contracted providers.
• Handle daily processing of retro, prior authorization review, ensuring proper level of care based on evidence-based criteria.

Skills

Nursing

Case Management

HIPAA

Communication

Education

Licensed Vocational Nurse (LVN)

Tools

Crystal Reports

Job description

Bakersfield Family Medical Group, Inc. is looking for an LVN Case Manager to review referrals for ambulatory and inpatient services, aligning with health plan criteria and CMS guidelines.

You will collaborate with the Medical Director and Utilization Management leadership, ensuring timely decisions and maintaining confidentiality. The role requires an LVN license, 3 years acute hospital experience, and experience in case management is recommended.