Care Manager I - LPN (Maryland)

Key Responsibilities

• Develop and initiate client-centred, comprehensive Individual Care Plans consistent with programme guidelines, policies and procedures.
• Identify, arrange and monitor appropriate community services, using strong knowledge of Medicare, Medicaid and other entitlement programmes.
• Coordinate and facilitate patient care through assessment, evaluation, planning and implementation, communicating needs to the care team and following up as required.
• Manage discharge plans and work collaboratively with patients, families, physicians and nurses to ensure high-quality care.
• Act as the patient’s advocate regarding insurance coverage and financial assistance.
• Maintain a comprehensive clinical record through detailed, accurate documentation.
• Coordinate an interdisciplinary approach to support timely access to appropriate care, ensure continuity among providers and optimise use of resources.
• Apply established care transition principles, following members through the continuum of care and coordinating warm hand-offs to appropriate providers and/or health plans.
• Assist the UM Manager and participate in all internal and external audits.
• Serve as primary liaison with contracted health plans for case management activities.
• Protect the privacy and security of PHI in line with Medical Group/MSO policies and HIPAA requirements.
• Perform other duties and special projects as assigned.

Skills, Knowledge & Expertise

• Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN) required
• Two (2) years’ utilization management experience applying evidence-based clinical criteria and benefit plans required
• Three (3) years’ clinical experience, preferably in case management or a related area, required

• Bachelor’s degree in nursing or a related health services field
• Certified Case Manager (CCM) certification preferred
• Tagalog or Ilocano language skills preferred

Benefits

• This is a remote position. This position is based in the Maryland area.
• The total compensation target pay range for this role is: $31.00 - $40.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.