LVN Case Manager Assistant at Kaiser Permanente

Downey, California, United States -

Full Time

Start Date

Immediate

Expiry Date

02 Jan, 26

Salary

0.0

Posted On

04 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Organizational Skills, Verbal Communication, Written Communication, Problem Solving, Computer Literacy

Industry

Medical Practices

Description

%3Cdiv%3E %3Cb%3EJob Summary:%3C/b%3E%3C/div%3E %0A%3Cp%3EThe LVN/LPN Case Manager Assistant is responsible to conduct medical necessity screening and work collaboratively with the interdisciplinary team to provide care coordination for patients under the direction of a Registered Nurse and in compliance with evidence-based practice and regulatory requirements. This position complies with the scope of services defined by the Licensed Vocational /Practical Nurse LVN/LPN state licensure requirements. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention, Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care, Compliance with state and federal regulatory requirements, TJC accreditation standards and policy Education provided to physicians, patients, families and caregivers, and other duties assigned.%3C/p%3E%3Cdiv%3E%3C/br%3E%3Cb%3EEssential Responsibilities:%3C/b%3E%3C/div%3E %0A%3Cul style=%27margin-top: 0;margin-left: 1px;margin-bottom: 0;%27%3E%3Cli%3EThe individuals responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review b) care coordination, c) implementation of the transition plan based on RN Case Manager and/or Social Worker (SW) assessment(s), d) communication with interdisciplinary team during patient care conferences, e) management of concurrent disputes, f ) communication with patients and families regarding the plan of care established by RN, SW and Physician, g) collaboration with physicians, office staff and ancillary departments, h) clear, complete and concise documentation in electronic system, i) maintenance of accurate patient demographic and insurance information, j) identification and documentation of potentially avoidable days, k) identification and reporting of over and underutilization , l) and other duties as assigned%3C/li%3E%3Cli%3EUtilization Management:%3C/li%3E%3Cli%3EAssures the patient is in the appropriate status and level of care based on Medical Necessity process and submits for Secondary Physician review per Kaiser policy%3C/li%3E%3Cli%3EEnsures timely communication of clinical data to various payers to support admission, level of care, length of stay and authorization for post-acute services%3C/li%3E%3Cli%3EAdvocates for the patient and hospital with payers to secure appropriate payment for services rendered%3C/li%3E%3Cli%3ECompletion of clinical reviews%3C/li%3E%3Cli%3EPromotes prudent utilization of all resources (fiscal, human, environmental, equipment and services) by evaluating resources available to the patient and balancing cost and quality to assure optimal clinical and financial outcomes%3C/li%3E%3Cli%3EIdentifies and documents Avoidable Days using the data to address opportunities for improvement%3C/li%3E%3Cli%3EPrevents denials and disputes by communicating with payers and documenting relevant information%3C/li%3E%3Cli%3ECoordinates clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) supported by evidence-based practice, internal and external requirements.%3C/li%3E%3Cli%3EIdentifying appropriate level of care needs%3C/li%3E%3Cli%3EAssisting with patient transition to the appropriate level of care%3C/li%3E%3Cli%3EOrder clarification admission status and patient classification.%3C/li%3E%3Cli%3EMaintain and foster timely and accurate with all members if the multidisciplinary team.%3C/li%3E%3Cli%3EEscalates barriers to patient care as appropriate%3C/li%3E%3Cli%3EOther duties assigned.%3C/li%3E%3Cli%3E(30%25 daily, essential).%3C/li%3E%3Cli%3ETransition Management:%3C/li%3E%3Cli%3EMakes referrals for post-acute services based on %26nbsp;needs identified by the RN Case Manager or SW staff assessment and utilizing the electronic Case Management system%3C/li%3E%3Cli%3EProvides patients and families with choices of post-acute providers per Kaiser policy.%3C/li%3E%3Cli%3EBased on SW and RN assessment and plan follows up on readmitted patients and implement strategies to address opportunities outlined.%3C/li%3E%3Cli%3EEnsures all elements of the transition plan are implemented and communicated to the healthcare team, patient/family and post-acute providers.%3C/li%3E%3Cli%3EIdentifies and reports variances in appropriateness of medical care provided, over/under utilization of resources compared to evidence-based practice and external requirements. This priority includes documentation in the Case Management system to communicating information through clear, complete and concise documentation%3C/li%3E%3Cli%3E(30%daily, essential)%3C/li%3E%3Cli%3ECare Coordination:%3C/li%3E%3Cli%3EFollows up on patients identified by the SW and /or RN Case Manager on factors that may affect the progression of care%3C/li%3E%3Cli%3EEnsures consults, testing and procedures are sequenced to support the patients clinical needs with timely and efficient care delivery%3C/li%3E%3Cli%3EEnsures patient needs are communicated and that the healthcare team is mutually accountable to achieve the patient plan of care%3C/li%3E%3Cli%3EEffectively collaborates with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical and transition outcomes.%3C/li%3E%3Cli%3E(15%25 daily, essential).%3C/li%3E%3Cli%3EEducation:%3C/li%3E%3Cli%3EContributes to the education to patients %26nbsp;and the care team relevant to the%3C/li%3E%3Cli%3EEffective progression of care,%3C/li%3E%3Cli%3EAppropriate level of care, and%3C/li%3E%3Cli%3ESafe and timely patient transition%3C/li%3E%3Cli%3EProvides patients and healthcare team information regarding resources and benefits available to the patient along with the economic impact of care options%3C/li%3E%3Cli%3EEnsures that education has been provided to the patient/family/caregiver by the healthcare team prior to discharge%3C/li%3E%3Cli%3E(15%25 daily, essential).%3C/li%3E%3Cli%3ECompliance:%3C/li%3E%3Cli%3EEnsures compliance with federal, state, and local regulations and accreditation requirements impacting case management scope of services%3C/li%3E%3Cli%3EAdheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Kaiser policies.%3C/li%3E%3Cli%3EOperates within the LVN/LPN scope of practice as defined by state licensing regulations%3C/li%3E%3Cli%3ERemains current with Kaiser Utilization Management/Case Management practices%3C/li%3E%3Cli%3E(10%25 daily, essential)%3C/li%3E%3Cli%3EPRIMARY INFORMATION, TOOLS AND SYSTEMS USED:%3C/li%3E%3Cli%3EPatient data - hospital admission, discharge, transfer system%3C/li%3E%3Cli%3EHealthcare staff documentation related to patient care%3C/li%3E%3Cli%3ERegulatory and payor requirements%3C/li%3E%3Cli%3EKaiser Plan benefits%3C/li%3E%3Cli%3EHealth Connect%3C/li%3E%3Cli%3ETapestry%3C/li%3E%3Cli%3EMcKesson Care Enhance Review Manager (CERMe) InterQual system%3C/li%3E%3Cli%3EClinical data interface and secure faxing%3C/li%3E%3Cli%3EPatient Medical Record including Health Connect and Tapestry%3C/li%3E%3Cli%3EHospital specific Clinical Software%3C/li%3E%3Cli%3EPERFORMANCE METRICS AND EVALUATION:%3C/li%3E%3Cli%3EThe metrics below provide an indication of the effectiveness of the individual in this role and may be used for evaluative purposes. The list below is not meant to be exhaustive; other relevant metrics may exist.%3C/li%3E%3Cli%3EInterQual reviews%3C/li%3E%3Cli%3EObservation hours%3C/li%3E%3Cli%3EExcess Days/ALOS%3C/li%3E%3Cli%3EPatient Day Rate%3C/li%3E%3Cli%3EIQM metrics%3C/li%3E%3Cli%3ENumber and type of avoidable days%3C/li%3E%3Cli%3EResource Utilization%3C/li%3E%3Cli%3ESUPERVISORY RESPONSIBILITIES:%3C/li%3E%3Cli%3ENone%3C/li%3E%3C/ul%3E Basic Qualifications: Experience Minimum two (2) years of hospital or ambulatory or post-acute experience. Education High School Diploma or General Education Development (GED) required. License, Certification, Registration Vocational Nurse License (California) Additional Requirements: Skills required include excellent organizational skills, excellent verbal and written communication skills, demonstrated problem solving skills, and computer literacy. Must complete InterQual test and pass with a score of 85 or better within 60 days of hire and annually. Must complete and demonstrate competency in using the Kaiser/Utilization Management/Case Management documentation system within 60 days of hire. Attendance at hospital and department orientation is required. Department orientation includes review and instruction regarding Utilization Management/Case Management, Compliance policies, InterQual, Transition Management, and other topics specific to case management. Preferred Qualifications: Hospital Case Management experience preferred. Notes: Cross coverage service areas Rotating weekends

Responsibilities

The LVN Case Manager Assistant conducts medical necessity screening and collaborates with the interdisciplinary team to provide care coordination for patients. This role ensures compliance with evidence-based practices and regulatory requirements while supporting the RN and SW in patient care.