Care Manager LVN

Job Description

Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent communication, both verbal and written, and facilitates care along a continuum through effective resource coordination. The goal of the Care Manager is to advocate for and assist the patient in the achievement of optimal health, access to care, and appropriately utilizing resources. The LVN Care Manager utilizes the following processes to meet the patient’s individual healthcare needs: collects data, assists in planning, implementation, coordination, monitoring and evaluation of the plan of care.

The management of resources and the coordination of the continuum of care will be performed in a manner consistent with the mission vision and core values of St. Joseph Health. Essential Values-Based, Competencies: Demonstrates values-based competencies in line with the four core values that are the foundation of all activities performed by employees in order to achieve the Mission of the St. Joseph Health System.

Dignity: Demonstrates competence in communication and interpersonal relations. Excellence: Demonstrates competence in continuous improvement, continuous learning, accountability, and teamwork. Service: Demonstrates competence in customer/patient focus and adaptability. Justice: Demonstrates competence in community orientation and stewardship.Essential Functions: • Data Collection: The Care Manager will collect in-depth information about a persons’ situation and functional status to identify individual needs in order to develop a comprehensive plan of care that will address the patient’s needs.

The Care Manager will identify both present and possible future needs of the patient and family, which may affect the plan of care and the patient’s well-being. This data will include age-specific physical, psychosocial, environmental, financial, and health status expectations. When performing Utilization review – will collect the necessary information regarding medical necessity using evidence based guidelines.• Planning: The Care Manager will assist with the identification of specific objectives, goals and actions, as identified during the collection of data. Acting as a patient advocate the Care Manager will collaborate with the physician, the patient & family, and members of the healthcare team, to formulate a shared plan of care.

Goals and time frames for goals, appropriate to the patient, will be set. When performing utilization review, will plan for timely interventions in order to facilitate appropriate care and authorizations.• Implementation: Executes specific interventions that will lead to accomplishing the goals and timeframes of the shared plan of care but Works effectively with the healthcare team to determine the necessary steps to achieve the plan of care. Problem solving techniques will be applied to the implementation process. The Care Manager will utilize knowledge of alternative funding sources, benefit plans, and contractual information to promote appropriate quality, cost effective care for members throughout the healthcare continuum.• Coordination: Organizes, coordinates, provides, modifies or obtains appropriate authorizations, utilizing appropriate utilization review and evidence of coverage guidelines, to accomplish the patient’s goals.

Initiates and communicates with the patient and family, physicians, healthcare members, community and payor representatives. Facilitates continuity of care throughout all access points involving Health Plan, discharge planners, physicians and other appropriate staff. Processes referrals and authorizations according to regulatory and payor requirements and within Heritage’s mission, vision, values and business requirements. • Monitoring: Obtains sufficient information from all relevant resources in order to determine the effectiveness of the plan of care, and/or services provided.

Manages a caseload of high risk, complex needs and/or catastrophic patients. • Evaluation: At appropriate and repeated intervals, evaluates the patients’ progress. If progress is static or regressive, determines the reason and encourages the appropriate interventions to obtain optimal outcomes, including communication with healthcare team. The Care Manager will modify the plan of care, as necessary, in coordination with the healthcare team, family members, and providers.

• Communication: Communicates both verbally and electronically with the patient and the healthcare team. Appropriately documents the plan of care, patient progress, outcomes, statistical reporting, logs, and files abiding to departmental, legal and regulatory requirements. Additional Responsibilities: • Performs all other duties as assigned.Age-Related Competencies: • Human development knowledge/skills: Demonstrates the knowledge and skills necessary to coordinate care appropriate to the age of the patients served including knowledge of the principles of growth and development and psychosocial characteristics and interventions for any age member of our network.• Age-specific patient needs that employee is required to understand and meet: Demonstrates the ability to gather age appropriate data about the member’s status in order to identify age-specific needs and coordinate the care needed.• Additional requirements: Demonstrates age appropriate communication skills for the patient population served.Demonstrates knowledge of age-specific community resources. Information Management: Treats all information and data within the scope of the position with complete confidentiality and security.

Maintains all practices to protect PHI and adheres to HIPAA standards. Risk Management: Cooperates fully in all risk management activities and investigations. Safety Requirements: Is knowledgeable of, observes and complies with the organization Codes of Safe Practice, safety policies and emergency procedures.Minimum Position Qualifications: Education: Requires an Associate’s degree in Healthcare. A high school diploma or GED with graduation from an accredited nursing program from a college or vocational school with two (2) years’ related work experience may be substituted.

Experience: Requires two (2) plus years of clinical experience in an HMO, medical group, affiliated model, hospital or medical office/clinic setting.License / Certification: Active California LVN license.Computer Skills: Basic computer skills including Windows, Microsoft Word, internet navigation and an e-mail system. Other: Valid California driver’s license and automobile insurance for employee-owned vehicles.Knowledge / Skills / Abilities: • Knowledge of managed care principles, utilization management, case management and healthcare provided throughout the continuum.• Knowledge of physical and psychological characteristics of disease processes, recognizes potential clinical problems, and recommends intervention in a preventative, pro-active way. • Excellent interpersonal, verbal and written communication skills.• Ability to problem-solve.• Ability to coordinate community resources to meet patient’s needs.• Ability to handle multiple tasks at a time and remain organized.• Ability to work autonomously but demonstrates the ability to work collaboratively on a team. • Ability to work in an ambiguous environment; work effectively under pressure due to changes in priorities.• Excellent computer and IT system knowledge.• Possesses the knowledge and skills necessary to communicate with third party payers.

• Establishes and maintains a good rapport with physicians and interacts well with all internal and external customers in a professional and courteous manner. • Ability and willingness to travel between SJHH locations. Preferred Position Qualifications: Education: Bachelor’s degree in a healthcare related field highly desirable. Experience: Three (3) years’ experience in utilization management and/or case management highly desirable.License / Certification: • Certification in Case Management (CCM, ACM).• Specialty Certification in Oncology, Rehab, Pediatrics, Transplant or Wound CareOther: Proficiency in Milliman (Mcg) Care Guidelines.

St. Joseph Heritage Healthcare (SJHH) is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, SJHH has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values.St.

Joseph Heritage Healthcare (SJHH) provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, St. Joseph Heritage Healthcare (SJHH) complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

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