RN/ LVN Case Manager

We are looking for an experienced RN/LVN Case Manager to coordinate patient care, assess patient needs, develop care plans, coordinate referrals, and support patients throughout their healthcare journey.

Key Responsibilities

1. Assess patients’ medical, functional, safety, nutritional, and psychosocial needs.
2. Develop and maintain individualized care plans.
3. Monitor patient progress, hospitalizations, ER visits, and readmissions.
4. Coordinate care with doctors, specialists, hospitals, patients, families, and healthcare providers.
5. Coordinate referrals, authorizations, and community resources.
6. Provide patient and family education.
7. Support discharge planning and continuity of care.
8. Manage high-risk, complex, high-cost, and high-utilization cases.
9. Participate in Interdisciplinary Care Team (ICT) meetings.
10. Maintain accurate and confidential patient records in compliance with HIPAA.
11. Prepare case summaries, reports, and required documentation.
12. Follow case management, health plan, state, and federal requirements.
13. Use InterQual, Milliman, or similar medical necessity guidelines when applicable.

Qualifications

1. Active PHRN or USRN License
2. California RN or LVN License – preferred, but not required
3. 2+ years US healthcare experience
4. 2+ years acute care experience
5. 2+ years managed care experience
6. Case management experience preferred
7. Experience with referrals and authorizations preferred
8. Knowledge of medical terminology and healthcare coding (ICD-9, CPT, HCPCS)
9. Strong communication and documentation skills
10. Basic Microsoft Office and computer skills
11. Ability to work independently and remotely
12. Bilingual skills are a plus

📍 Location: Remote | PH-Based Employees Only