LVN Case Manager – Utilization & Care Coordination

Bakersfield Family Medical Group; Bakersfield (CA); On-site; USD 42,000 - 49,000; Full time

Job summary

Bakersfield Family Medical Group seeks an LVN Case Manager to review referrals for ambulatory care, elective inpatient services, and durable medical equipment under Utilization Management. You will work with the Medical Director and care teams to ensure evidence-based, compliant decisions and maintain strong provider relationships.

The role emphasizes successful handling of denials, rapid response to questions, and collaboration across departments, with annual compliance trainings and patient

Qualifications

• Knowledge of health plan and CMS regulations and guidelines.
• Experience coordinating utilization management referrals and denials.
• Ability to communicate with physicians, staff, and members professionally.

Responsibilities

• Coordinate the UM process per health-plan criteria.
• Obtain and document pertinent information for referrals.
• Serve as clinical liaison for UM with Medical Director and leadership.
• Maintain HIPAA compliance and patient safety.
• Review complex cases with Medical Director and UM leadership.
• Communicate with providers and patients about UM questions.
• Generate and analyze reports to monitor turn-around times.
• Assist in writing denial letters with Denial Coordinator.

Skills

HIPAA compliance

Clinical liaison

Communication

Detail oriented

Education

Graduate from an accredited school of Nursing

Valid State License as LVN

Three years acute hospital experience

Case management experience (recommended)

Tools

Crystal Reports

Job description

Bakersfield Family Medical Group seeks an LVN Case Manager to review referrals for ambulatory care, elective inpatient services, and durable medical equipment under Utilization Management. You will work with the Medical Director and care teams to ensure evidence-based, compliant decisions and maintain strong provider relationships.

The role emphasizes successful handling of denials, rapid response to questions, and collaboration across departments, with annual compliance trainings and patient