LVN Case Manager - La Palma, CA

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The LVN Case Manager is responsible for managing low and moderate risk Special Needs Population (SNP) and Dual Eligible (DE) members. SNP / CMC Care Manager will ensure that the SNP and DE receive an assessment. Ensures the individualized care plan is developed and presented timely to the IDCT.

Standard Hours: Mon-Fri 8:00am-5:00pm. No nights, weekends or holidays.

Primary Responsibilities:
  • Managers a case load of 400 - 600 low to moderate risk SNP and or CMC members
  • Coordinates and schedules all IDCT meetings
  • Ensures all SNP and DE members are presented at IDCT at least annually
  • Facilitates Primary Care Provider attendance
  • Ensures SNP and DE member and or caregiver participation
  • Oversees the low risk SNP and DE population and ensures the annual review of the care plan is completed for those members who did not have a change in health status
  • Works collaboratively with the patient, physician, family / significant other and providers of healthcare to implement plan of care to meet the individual needs
  • Works collaboratively with discharge planners at the affiliated hospitals and case management staff to identify changes in health status
  • Monitors care, which is easily accessible with no access barriers as related to the patient's available benefits
  • Provides accurate and up - to - date information to practitioners regarding clinical practice guideline criteria and patient information
  • Creates individualized treatment plans that incorporate the HRA, community LTSS services

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • High School Diploma or GED
  • Current and unrestricted LVN license for the state of California
  • 2+ years of experience in a managed care environment, preferably in an IPA or MSO. Other case management experience will be considered
  • Basic level of experience with Microsoft Word, with the ability to navigate a Windows environment
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:
  • Associates Degree in Nursing (ASN)
  • Bachelor's degree in nursing (BSN)
  • Case Management Certification (CCM)
  • Bilingual Spanish speaking (ability to read, write, speak)
  • Knowledge of and experience with the utilization of UM criteria such as Milliman & Robertson, Medicare and Medicaid guidelines, health plan criteria, etc.
  • Experience as a case manager, experience with utilization management
  • Experience working with Medicare members


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*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: UM LVN Case Manager, UM RN Case Manager, Nurse Care Manager, RN, Case Management, Certification In Case Management (CCM), BSN, Utilization Management, Quality Improvement, Discharge Planning, Skilled, SNF, Milliman, Applecare, La Palma, Anaheim, Long Beach, Santa Ana, CA, California

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