LVN, High Risk Care Manager

SIERRA MEDICAL GROUP, INC; Palmdale (CA); On-site; USD 44,000 - 47,000; Full time

Benefits offered by this job

401(k) with company match

Disability insurance

Employee assistance program

Flexible spending account

Health insurance

Life insurance

Paid time off

Vision insurance

Job summary

SIERRA MEDICAL GROUP, INC is seeking a Full-time High Risk Care Manager (HRCM) in California to assess, plan, and coordinate outpatient care for high-risk members. You will collaborate with PCPs, families, and healthcare teams to develop and monitor care plans and reduce unnecessary admissions.

Responsibilities include clinical assessments, care plan implementation, transitions of care, and ensuring documentation compliance across medical records.

Qualifications

• Current LVN license with IV certification is required.
• Bi-lingual English/Spanish is required.
• Strong communication and care coordination skills.

Responsibilities

• Function as liaison between administration, members, physicians and providers.
• Develop and implement an acuity-based plan of care with input from members.
• Perform clinical assessment and determine follow-up needs.
• Educate members and caregivers on transitions of care.
• Coordinate clinic appointments and medication reconciliation.
• Meet with members in clinic, home, hospital or community.
• Document assessments and plans in medical records.
• Adhere to all compliance policies and procedures.

Skills

Bi-lingual English/Spanish

Care coordination

Communication

Education

Licensed Vocational Nurse (LVN) license

IV Certification

Job description

The High Risk (Outpatient) Care Manager (HRCM) is responsible for assessment, treatment planning, intervention, monitoring, evaluation, and documentation on identified High Risk members.

The HRCM will assess and develop a care plan in collaboration with the Primary Care Physician, members and other health care practitioners as needed.

The goal of HRCM is to effectively manage members on an outpatient basis to ensure the appropriate level of care is provided, to prevent in patient admission and re-admissions, and ensure that the members’ medical, environmental, and psycho-social needs are met over the continuum of care.

ESSENTIAL DUTIES and RESPONSIBLITIES:

• Function as liaison between administration, members, physicians, and other healthcare providers.
• Interact professionally with members/family/physicians and involves members/family/physicians in formation of the plan of care.
• Performs a Clinical Assessment/Questionnaire of the member and determines an acuity score for necessary scheduled follow-up.
• Develops an outcome-based plan of care, based on the member’s input and assessed member needs.
• Implements and evaluates the plan of care as often as needed as evidenced by documentation in the members' case file(s).
• Documents member assessment and reassessment, member care plans, and other pertinent information completed in the members’ medical records.
• Identifies planned and unplanned transitions of care from requests for services or daily in-patient and SNF census.
• Educates the member/caregiver on the transition process and how to reduce unplanned transitions of care.
• Manages transition of care from the sending to receiving settings ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member’s health care status changes.
• Communicates appropriately and clearly with physicians, in-patient case managers, and Prior-Authorization team.
• Identifies and addresses pharmacological needs of the members and facilitates consultations with the pharmacy department, as necessary.
• Identifies and addresses psychosocial needs of the members and family and facilitates consultations with Social Worker, as necessary.
• Responsible for the coordination of clinic appointments, medication reconciliation, PCP and SPC visits.
• Meet with members/caregiver face to face in various locations (clinic, home, hospital, and community) to build a rapport with members to better support member/caregiver with care coordination and the appropriate plan of care.
• Perform other duties as assigned by management.

ADHERENCE to POLICIES:

• Promote organizational goals.
• Know and follow Employee Handbook and all other company Policies and Procedures Manual(s).
• Communicate respectfully with members, families, co-workers, and all those encountered in workday.
• Communicate verbally and in writing through proper channels.
• Adhere to all Compliance Regulations including, HIPAA, Fraud, Waste, and Abuse, Harassment, Code of Conduct, Model of Care, Cultural and Linguistics, and Injury and Illness.
• Participate in required meetings and follow meeting protocols.
• Follow all company policies and procedures.

COMPLIANCE STATEMENT:

This position requires that the Employee abide by the Company’s Compliance Plan (including its Standards of Conduct) and all Compliance Policies and Procedures (as listed on the Company’s Intranets or Internet pages under Compliance). This position further requires the Employee to act with the highest standards of integrity and professional ethics. This would include but is not limited to the expectation and requirement that the Employee immediately report any potential Compliance, Security or Privacy, or potential Fraud‑Waste‑Abuse violations or issues to the Company’s Compliance Officer, Compliance Hotline, and/or to any Officer of the Company.

FULL-TIME BENEFITS INCLUDE:

• 401(k) with company match
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

The pay range for this position at commencement of employment is expected to be between $32.00/hour to $34.00/hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Requirements

• Current LVN License with IV Certification
• Current Basic Life Support (BLS) certification
• Bi-lingual - English and Spanish
• Current Driver's License andAutomobile Insurance
• Ability to work well with team members, patients, and families.

Monday - Friday: 8:00 AM - 5:00 PM