Case Manager - LVN (Enhanced Care Management)

apartment Astrana Health location_onMonterey Park, CA 91754, US

Apply Now

$60,000 - $80,000 / HOUR

Apply Now

Case Manager - LVN (Enhanced Care Management)

Department: HS - ECM

Employment Type: Full Time

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Reporting To: Tanaka Nhong

Compensation: $60,000.00 - $80,000.00 / hour

Description

We are currently seeking a highly motivated LVN Lead Care Manager for our Enhanced Care Management (ECM) team. ECM is a Medi-Cal benefit that links high risk members to various resources in the community. You will be responsible for doing assessments and creating care plans based on those assessments for your caseload, as well as following up with members throughout their time in the ECM program.

We are ideally seeking candidates who have prior experience with care management, complex case management, home health, dialysis, D-SNP case management, or managed care.

Our Values:

Put Patients First
Empower Entrepreneurial Provider and Care Teams
Operate with Integrity & Excellence
Be Innovative
Work As One Team

What You'll Do

Manage a caseload of 50-100 Medi-Cal members with complex medical and social needs, adhering to DHCS and Model of Care requirements.
Conduct timely outreach, comprehensive assessments (HRA), risk stratification, and individualized care planning.
Coordinate transitions of care, including hospital discharges and PCP follow-ups, ensuring continuity and quality of care.
Collaborate with community health workers and interdisciplinary teams to address medical, behavioral, and social needs.
Perform medication reconciliations, review claims/authorization data, and evaluate assessment findings using evidence-based guidelines.
Identify barriers to care, provide education using motivational interviewing and trauma-informed approaches, and adjust care plans based on member readiness and outcomes.
Connect members to social services (e.g., transportation, housing, support programs) and facilitate care across settings (home, hospital, SNF, community).
Participate in interdisciplinary team meetings, health plan audits, and seminars, ensuring compliance with organizational and regulatory standards.
Other duties as assigned.

Qualifications

Current and active LVN CA license
Experience with clinical issues and guidelines
Excellent analytical, critical reasoning, organizational and interpersonal communication skills
Strong written and oral communication skills
Ability to multi-task, work autonomously, and think outside the box
Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information is required.
Proficient with Microsoft Office (Word, Excel, Power Point)

You're great for this role if you have:

Knowledge of enhanced case management, SNP case management, complex case management
Experience in managed care environment – health plans, IPA, or MSO
1+ years of Case Manager experience
Basic knowledge of DHCS, DMHC, NCQA, ICE, and CMS standards
Bachelor's degree

Environmental Job Requirements and Working Conditions

Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
The total compensation target pay range for this role is between $28 - $38 per hour, depending on credentials and experience. The salary range represents our national target range for this role.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.

Share this job

Related Jobs

LVN - Schools | Home Health

apartment Maxim Healthcare Services location_onOrange, CA

Hourly salary ranging from $30-$34 Maxim Healthcare Services in Orange County, CA is looking for a Licensed Vocational Nurse (LVN) to assume responsibility and accountability for the application of the nursing process and the delivery of patient care. The Licensed Vocational Nurse (LVN) will consistently perform according to nursing standards and is accountable in managing patient care and assisting others in the management of patient care. We are currently looking for to fill multiple cases including: Mornings, Afternoons, Overnights, and Weekends. If this is a position that you are currently looking for feel free to contact Darlene Edolmo directly at (714) 542-2400. Example shift times would be - 7am-3pm ; 3pm-11pm ; 11pm-7am We offer opportunities for School and Home settings. Responsibilities Utilizes the nursing process to assess, plan, implement and evaluate patient care. Performs focused interview to identify specific patient needs. Assess signs and symptoms indicating physiologic and psychosocial changes in the patient’s condition. Collects, analyzes, and interprets data and information from health care members and documents actual and/or potential nursing diagnoses. Other Licensed Vocational Nurse (LVN) duties as assigned. Qualifications Current Licensed Vocational Nurse (LVN) License in the state in which the Licensed Vocational Nurse (LVN) practices. Current Health Certificate (per facility). Current PPD or Chest X-Ray. Current BLS card. One year prior Licensed Vocational Nurse (LVN) experience preferred. Maxim Benefits: Health and Wellness Medical/Prescription, Dental, Vision, Health Advocacy (company paid if enrolled Medical) and Health Advocate Employee Assistance Program Retirement and Financial Security: Health Savings Account, 401(k), Short Term Disability, Voluntary Group Life Insurance and Supplemental Accidental Insurance, Hospital Expense Protection Plan, Critical Illness Insurance, Home and Auto Insurance discounts, Pet Insurance and Legal Benefits Lifestyle Benefits: Paid Time Off, Employee Discount Program, Transportation Benefits and College Partnership Program *Benefit eligibility is dependent on employment status. About Maxim Healthcare Maxim Healthcare has been making a difference in the lives of our patients, caregivers, employees and communities for more than 30 years. We offer private duty nursing, skilled nursing, physical rehabilitation, companion care, respite care and behavioral care for individuals with chronic and acute illnesses and disabilities. Our commitment to quality customer service, compassionate patient care, and filling critical healthcare needs makes us a trusted partner wherever care is needed. Maxim Healthcare, Inc. (“Maxim”) is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.

LVN

Full-time

LVN UM Delegation Oversight Nurse Remote based in CA

apartment Molina Healthcare location_onLong Beach, CA

JOB DESCRIPTION Job Summary Provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care. The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the team. We are looking for LVN's with at least 4 years of UM experience, NCQA accreditation, and knowledge of InterQual / MCG guidelines. Excellent computer knowledge, multi-tasking skills and analytical thought process is important to be successful in this role. Productivity is important with quick turnaround times. Experience with Appeals, Auditing, and Compliance /Quality will be a good fit for this position. Strong UM Prior Authorization experience highly preferred. Further details to be discussed during our interview process. CA located – Remote position Work hours: Monday – Friday 8:00am – 5:00pm PST CA LVN licensure required Essential Job Duties • Coordinates, conducts and documents pre-delegation and annual assessments as necessary to comply with state, federal and National Committee for Quality Assurance (NCQA) guidelines, and other applicable requirements. • Distributes audit results letters, follow-up letters, audit tools and annual reporting requirement as needed. Works with delegation oversight analytics representatives on monitoring performance reports from delegated entities. • Develops corrective action plans (CAPs) when deficiencies are identified, and documents follow-up to completion. • Assists with delegation oversight committee meetings. • Works with delegation oversight leadership to develop and maintain delegation assessment tools, policies and reporting templates. • Assists with preparation of delegation summary reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. • Participates as needed in joint operation committees (JOCs) for delegated groups. • Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid, National Committee for Quality Assurance (NCQA) and/or other regulatory audits as needed. Required Qualifications • At least 3 years experience in health care, including 2 years experience in a managed care environment facilitating utilization reviews, or equivalent combination of relevant education and experience. • Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. • Knowledge of audit processes and applicable state and federal regulations. • Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet established deadlines. • Ability to collaborate effectively with team members and internal departments. • Strong attention to detail with a focus on maintaining quality in all tasks. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified Professional in Healthcare Quality (CPHQ). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $68,640 - $123,164 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

LVN

Full-time

LVN UM Delegation Oversight Nurse Remote in CA

apartment Molina Healthcare location_onLong Beach, CA

JOB DESCRIPTION Job Summary The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care. We are looking for LVN's with at least 2 years of experience with the following: UM, Prior Authorization, NCQA accreditation, and knowledge of InterQual / MCG guidelines. Excellent computer knowledge, multi-tasking skills and analytical thought process is important to be successful in this role. Experience with Appeals, Auditing, and Compliance /Quality will be a good fit for this position. Advanced Excel skills/ data analysis. Productivity is important with quick turnaround times. Further details to be discussed during our interview process. Work hours: Monday – Friday 8:00am – 5:00pm PST Remote position based in CA CA LVN licensure required Essential Job Duties Coordinates, conducts and documents pre-delegation and annual assessments as necessary to comply with state, federal and National Committee for Quality Assurance (NCQA) guidelines, and other applicable requirements. • Distributes audit results letters, follow-up letters, audit tools and annual reporting requirement as needed. • Works with delegation oversight analytics representatives on monitoring of performance reports from delegated entities. • Develops corrective action plans (CAPs) when deficiencies are identified, and documents follow-up to completion. • Assists with delegation oversight committee meetings. • Works with delegation oversight leadership to develop and maintain delegation assessment tools, policies and reporting templates. • Assists with preparation of delegation summary reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. • Participates as needed in joint operation committees (JOCs) for delegated groups. • Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid, National Committee for Quality Assurance (NCQA) and/or other regulatory audits as needed. Required Qualifications • At least 3 years experience in health care, including 2 years experience in a managed care environment facilitating utilization reviews, or equivalent combination of relevant education and experience. • Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). License must be active and unrestricted in state of practice. • Knowledge of audit processes and applicable state and federal regulations. • Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet established deadlines. • Ability to collaborate effectively with team members and internal departments. • Strong attention to detail with a focus on maintaining quality in all tasks. • Strong verbal and written communication skills. • Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Registered Nurse (RN). License must be active and unrestricted in state of practice. • Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified Professional in Healthcare Quality (CPHQ). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $68,640 - $123,164 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

LVN

Utilization Review

Full-time

Care Review Clinician LVN

apartment Molina Healthcare location_onLong Beach, CA

**California residents preferred. Candidates who do not live in California must be willing to work Pacific business hours. JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. •Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in a medical unit or emergency room. Previous experience in Managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. CALIFORNIA State Specific Requirements: Must be licensed currently for the state of California. California is not a compact state. WORK SCHEDULE: Tues - Sat shift will rotate with some holidays. Training will be held Mon - Fri To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $27.61 - $53.83 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

LVN

Utilization Review

Full-time

Care Review Clinician LVN

apartment Molina Healthcare location_onLong Beach, CA

California residents preferred. Candidates who do not live in California must work Pacific business hours permanently JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. • Analyzes clinical service requests from members or providers against evidence based clinical guidelines. • Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner. • Requests additional information from members or providers as needed. • Makes appropriate referrals to other clinical programs. • Collaborates with multidisciplinary teams to promote the Molina care model. • Adheres to utilization management (UM) policies and procedures. Required Qualifications • At least 2 years health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. • Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. • Ability to prioritize and manage multiple deadlines. • Excellent organizational, problem-solving and critical-thinking skills. • Strong written and verbal communication skills. •Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications • Certified Professional in Healthcare Management (CPHM). • Recent hospital experience in a medical unit or emergency room. Previous experience in Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. CALIFORNIA State Specific Requirements: Must be licensed currently for the state of California. California is not a compact state. WORK SCHEDULE: Tues - Sat with some holidays. Training will be held Mon - Fri To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $27.61 - $53.83 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.