- Develop and initiate client-centred, comprehensive Individual Care Plans
- Identify, arrange, and monitor appropriate community services
- Coordinate and facilitate patient care through assessment, evaluation, planning, implementation, communication, and follow-up
- Manage discharge plans and collaborate with patients, families, physicians, and nurses
- Advocate for patients regarding insurance coverage and financial assistance
- Maintain comprehensive clinical records through detailed, accurate documentation
- Coordinate interdisciplinary care to support timely access, continuity among providers, and resource optimization
- Apply care transition principles and coordinate warm hand-offs to appropriate providers and/or health plans
- Assist the UM Manager and participate in internal and external audits
- Serve as primary liaison with contracted health plans for case management activities
- Protect the privacy and security of PHI in line with Medical Group/MSO policies and HIPAA requirements
- Perform other duties and special projects as assigned
Requirements
- Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) required
- Two (2) years’ utilization management experience applying evidence-based clinical criteria and benefit plans required
- Three (3) years’ clinical experience, preferably in case management or a related area, required
- Bachelor’s degree in nursing or a related health services field
- Certified Case Manager (CCM) certification preferred
- Tagalog or Ilocano language skills preferred
- Knowledge of Medicare, Medicaid, and other entitlement programmes
- Knowledge of HIPAA requirements and PHI privacy and security
Core Competencies
Demonstrates expertise in developing and implementing Individual Care Plans, coordinating interdisciplinary patient care, and ensuring compliance with HIPAA and PHI regulations. Proficient in utilization management and case management with a strong focus on patient advocacy and community resource optimization.
Highest-signal resume keywords
- Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN)
- Utilization Management Experience
- Clinical Experience in Case Management
- Certified Case Manager (CCM)
- Knowledge of Medicare and Medicaid
Hard Skills
- Individual Care Plans
- Utilization Management
- Clinical Documentation
- Patient Advocacy
- Care Transition Principles
- Interdisciplinary Care Coordination
- Assessment and Evaluation
- Discharge Planning
- Evidence-Based Clinical Criteria
- Community Resource Optimization
Soft Skills
- Communication
- Collaboration
- Patient-Centered Care
- Problem-Solving
- Advocacy
Certifications & Qualifications
- Certified Case Manager (CCM)
Industry Keywords
- HIPAA Compliance
- PHI Privacy and Security
- Health Plans
- Entitlement Programs
- Clinical Experience
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Care Manager I – LPN Arbeitgeber: Jobtailor
Als Front Office Supervisor in unserem dynamischen Team bieten wir Ihnen die Möglichkeit, in einem unterstützenden und freundlichen Arbeitsumfeld zu wachsen. Wir legen großen Wert auf die berufliche Entwicklung unserer Mitarbeiter und bieten regelmäßige Schulungen sowie die Chance, Verantwortung zu übernehmen. Unsere Lage ermöglicht es Ihnen, Teil einer lebendigen Gemeinschaft zu sein, während Sie gleichzeitig die Standards unseres Franchise-Partners einhalten und unseren Gästen einen unvergesslichen Aufenthalt bieten.
