LVN​/LPN

Position Summary

The Case Manager Outpatient RN is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified High Risk members. The Case Manager Outpatient RN will assess and develop a care plan in collaboration with the admitting, attending and consulting physician, the member and other health care practitioners. The goal of the Case Manager Outpatient RN is to effectively manage members on an outpatient basis to assure the appropriate level-of-care is provided, to prevent inpatient admission and re‑admissions, and ensure that the member's medical, environmental, and psychosocial needs are met over the continuum of care.

• Keep member/family members or other customers informed and request further assistance when needed.
• Demonstrate the ability to follow through with requests, share critical information, and get back to individuals in a timely manner.
• Function as liaison between administration, members, physicians and other healthcare providers.
• Interact professionally with member/family/physicians and involve them in the formulation of the plan of care.
• Perform a Clinical Assessment/Questionnaire of the member and determine an acuity score for necessary scheduled follow‑up.
• Develop an outcome‑based plan of care based on the member's input and assessed needs. Implement and evaluate the plan of care as often as needed, as evidenced by documentation in the member's case file.
• Document member assessment and reassessment, member care plans, and other pertinent information completed in the member's medical record in accordance with the FOCUS Charting methodology, nursing standards, and company policies and procedures.
• Initiate community visits (hospital, home visits) as needed to assess patient progress and meet with appropriate members of the patient care team.
• Identify planned and unplanned transitions of care from Requests for Services or daily inpatient and SNF census.
• Educate the member/caregiver on the transition process and how to reduce unplanned transitions of care.
• Manage transition of care from the sending to receiving settings, ensuring that the Plan of Care moves with the member and updates/modifies the care plan as the member's health care status changes.
• Communicate appropriately and clearly with physicians, inpatient case managers and Prior‑Authorization nurses.
• Identify and address psychosocial needs of the members and family and facilitate consultations with Social Work as necessary.
• Identify and address pharmacological needs of the members and facilitate consultations with the pharmacy department as necessary.
• Identify community resources to address needs not covered by the member's benefit plan, and coordinate member benefits as needed with the health plan.
• Participate in the efficient, effective and responsible use of resources such as medical supplies and equipment.
• Coordinate and facilitate member and family conferences as determined by assessment of member's needs.
• Identify appropriate members to participate in the interdisciplinary case round process and prepare the necessary summary information to present to the team.
• Coordinate clinic appointments, medication reconciliation, PCP and SPC visits.
• Collaborate and communicate with all members of the healthcare team (concurrent review, pre‑authorization, PCP/SPC, Social Services, and Pharmacy) to coordinate the continuum of care of developing plans for management of each case.
• Identify members appropriate for hospice conversion or Palliative care.
• Meet with members/caregivers face‑to‑face in different locations (clinic, home, hospital, and community) to build rapport and better support care coordination and the plan of care.
• Perform other duties as assigned by management.

The pay range for this position at commencement of employment is expected to be between LVN $35‑$37.50 per hour and RN $45‑$50 per hour; base pay offered may vary depending on market location, job‑related knowledge, licensure, skills and experience. The total compensation package may also include a sign‑on bonus, discretionary awards and a full range of…