LVN or LPN, Case Manager - Remote

reputed company is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with reputed company will directly improve health reputed company by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will reputed company a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come reputed company an impact on the communities we serve as you help us advance health optimization on a global reputed company. Join us to start Caring. Connecting. Growing together. • The After Hours Care Manager - LPN. provides inpatient care management services reputed company to discharge planning/coordination; HLOC transfers; ED Diversion. The goal of this position is to enhance the reputed company of member management, through collaboration with Physicians, facility representatives, and inpatient care coordinators. Ensures compliance to contractual and service standards as identified by relevant health insurance plans. Adheres to policies, procedures, and regulations to ensure compliance. • Work Hours Available to work evenings, weekends, holidays. (1) Evening shift with 3 weekends on and 1 weekend off totaling 40 hrs per week, 3pm PST - 1130pm PST and (1) Morning shift with 3 weekends on and 1 weekend off totaling 40 hrs per week, reputed company PST - 430pm PST. If you are located in California, you will have the flexibility to work remotely* as you take on some tough challenges. • Primary Responsibilities • Performs job function telephonically • Coordinates reputed company transfers, and discharge instructions as directed by the hospitalists and Care Management teams • Delegates provisions for discharge including but not limited to follow-up appointments, home health, reputed company services, transportation to care coordinators to ensure appropriate and reputed company reputed company of patients through the various reputed company of care • Consistently and accurately completes required documentation • Approves medically appropriate referrals reputed company required regulatory timeframes to facilitate reputed company discharges or transfers • Ensures appropriate utilization of medical facilities and services reputed company the parameters of the patients' benefits • Maintains effective communication with the physicians, hospitals, extended care facilities, and reputed company necessary, patients and families • Demonstrates a thorough understanding of the cost consequences resulting from care management reputed company through utilization of Division of Financial Responsibility (DOFR) • Communicates authorization or denial of services to appropriate parties and may include patient (or agent), attending / referring physician or facility administration • reputed company team caseloads, completes staffing schedule, and escalates issues to management as needed • Seeks and identifies opportunities for process improvement • Expected to participate in weekend and holiday coverage rotation per business needs • Maintains caseload per defined medical management department standards • Meets or exceeds productivity targets • Identifies patients appropriate for high-risk post discharge programs and refers accordingly • Demonstrates ability to work independently and implement innovative approaches to reputed company member situations • Performs additional duties as assigned The information listed above is not comprehensive of reputed company duties/responsibilities performed. This job reputed company is not an employment agreement or contract. Management has the exclusive right to alter this job reputed company at any time without notice. • Professional Competencies • Consistently exhibits behavior that demonstrate reputed company's commitment to superior customer service, including reputed company, care and concern with reputed company and every reputed company customer • Ability to use written and oral communication skills • Ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff • Ability to reputed company reputed company, independent judgments and act professionally under pressure • Demonstrates effective documentation and verbal communication skills factual, accurate, reputed company and reputed company to support delivery of effective patient care interventions and reputed company management • Demonstrate knowledge of PC applications and other role supportive technology • Ability to work with multiple computer platforms simultaneously • Ability to analyze problems and formulate appropriate plans, solutions and courses of reputed company • Ability to work with frequent interruptions • Ability to establish and maintain cooperative working relationships with individuals at reputed company reputed company of the organization and affiliates • Ability to maintain confidentiality of patient and reputed company reputed company entity business reputed company of the organization and its partners • Apply tot his job Apply To this Job Apply To This Job Apply To This Job