Case Manager LVN-LPN

The Terraces at Los Altos
The Terraces at Los Altos - a Human Good community
373 Pine Lane
Los Altos, CA 94022, USA

The Terraces at Los Altos
The Terraces at Los Altos - a Human Good community
373 Pine Lane
Los Altos, CA 94022, USA

Make an impact beyond the bedside by helping residents successfully transition from skilled nursing to their next level of care. As a Case Manager – LVN/LPN, you’ll coordinate care and discharge planning for skilled nursing and post-acute residents, partnering with residents, families, clinical teams, physicians, payers, and community providers to support safe and timely transitions.

This role is ideal for an LVN/LPN who enjoys care coordination, problem-solving, resident and family communication, and interdisciplinary teamwork.

Schedule: Monday–Friday, 9:00 AM–5:30 PM

Pay Range: $42 - $52 per hour, depending on experience

• Manage a caseload of skilled nursing and post-acute residents from admission through discharge.
• Develop and coordinate discharge plans, identifying resident goals, caregiver support, potential barriers, and post-discharge needs.
• Partner with residents, families, nursing, rehabilitation, social services, physicians, payers, and outside providers to coordinate care and transitions.
• Coordinate follow-up services including home health, rehabilitation, medical equipment, medications, transportation, appointments, and community resources.
• Educate residents and families on discharge plans, follow-up care, medications, treatments, and available resources.
• Monitor resident progress, participate in interdisciplinary care planning, and accelerate clinical concerns or changes in condition as appropriate.
• Maintain accurate and timely case-management, care-planning, and discharge documentation.
• Support post-discharge follow-up, payer requirements, quality initiatives, and efforts to reduce avoidable readmissions.

• Current, active LVN or LPN license in the state of employment and graduation from an accredited nursing program.
• At least 2 years of licensed nursing experience in skilled nursing, post-acute care, rehabilitation, discharge planning, case management, or a related clinical setting.
• Experience with interdisciplinary care planning, discharge planning, care transitions, or post-acute service coordination.
• Strong communication, organization, documentation, and problem-solving skills.
• Current CPR/BLS certification and proficiency with electronic health records, as required.

• 3+ years of skilled nursing or post-acute nursing experience.
• Experience with Short Stay care coordination, PDPM, Medicare/Medicare Advantage, payer authorizations, or ACOs.
• Experience coordinating home health, DME, rehabilitation, transportation, appointments, and other discharge services.
• Familiarity with Point Click Care  , readmission-reduction initiatives, quality improvement, or care-transition programs.

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Equal Opportunity Employer
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