LVN Inpatient Case Manager

$40,498 - $79,206/Yr

UnitedHealth Group - San Jose, CA

Full-time - Entry Level

San Jose, CA

Insurance Carriers and Related Activities

About the position

The position involves ensuring continuity of care for patients in both inpatient and outpatient settings, utilizing nursing knowledge and resources to facilitate patient care and quality outcomes. The role requires effective communication and coordination with healthcare teams, patients, and families to implement treatment plans and manage care effectively.

Responsibilities

• Exhibit behavior and communication skills demonstrating commitment to superior customer service.
• Implement current policies and procedures set by the Care Management department.
• Conduct on-site or telephonic reviews of active patient care, including out-of-area and transplant cases.
• Review patients' clinical records of acute inpatient assignments within 24 hours of notification.
• Review patients' clinical records within 48 hours of SNF admission.
• Review patient referrals within specified care management policy timeframes.
• Coordinate treatment plans and discharge expectations.
• Discuss DPA and DNR status with the attending physician when applicable.
• Prioritize patient care needs and meet with patients and families to discuss care plans.
• Act as patient care liaison and initiate pre-admission discharge planning for high-risk patients.
• Identify and assist with follow-up of high-risk patients in various care settings.
• Consult with physicians and team members to ensure successful implementation of care plans.
• Coordinate discharge provisions, including follow-up appointments and home health services.
• Communicate authorization or denial of services to appropriate parties.
• Attend Care Management Committee meetings and report on patient status.
• Understand cost consequences of care management decisions through appropriate reports.
• Ensure appropriate utilization of medical facilities and services within patient benefits.
• Maintain effective communication with health plans, physicians, and patients.
• Provide accurate information regarding health plan benefits and community resources.
• Initiate data entry into IS systems of all patients according to Care Management policies.
• Maintain accurate documentation of care rendered, including relevant codes and referral types.
• Follow patients on ambulatory care management programs to optimize clinical outcomes.
• Use, protect, and disclose patients' protected health information in accordance with HIPAA standards.

Requirements

• Graduation from an accredited Licensed Vocational Nurse program.
• Current LVN license in California.
• 1+ years of recent clinical experience working as an LVN/LPN.
• 1+ years of experience in an HMO or Managed Care setting.

Nice-to-haves

• 1+ years of care management, utilization review or discharge planning experience.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution