Salary Range: $22.22 to $30.68 Hourly

Summary:

Under the direct supervision of the Director of Managed Care Services, the Referrals Case Manager, LVN is responsible for providing case management and care coordination support for assigned and complex specialty referrals cases. Assures that all specialty and ancillary referrals are processed and completed in a timely manner as per policy. Responsible for submitting monthly department reports to the Director of Managed Care. Works closely with the clinical team and IPA/HMO and specialist network representatives to coordinate appropriate patient level of care.

Duties:

• Responsible for providing Referrals Case Management for assigned and complex specialty referrals cases in compliance with UM Policy 107.
• Responsible for providing support to the Director of Managed Care with direct supervision of the Referrals Team, including monitoring assignments and performance, coordinating and providing team coverage as needed, as well as providing referrals staff training and evaluations.
• Responsible for assuring assigned referrals are completed in a timely manner per Arroyo Vista policy and contracted IPA/Health Plan and LA County DHS timelines care coordination standards. Assures all assigned urgent referrals are processed within 48 hours with the objective of minimizing risk exposure and facilitating continuity of quality care.
• Responsible for working closely with the Clinical Team, IPA/HMO and specialist network representatives to coordinate appropriate patient level of care. Responsible for monitoring and tracking incoming consultation reports to ensure PCP received and signed-off on reports, and that any findings requiring follow up have been completed. Reports to Director of Managed Care accordingly.
• Responsible for preparing, assisting, and submitting monthly and quarterly data and narrative reports to the Director of Managed Care. Responsible for collecting and reporting data and other information as requested by IPA/HMO and other agencies. Keeps the Director of Managed Care updated on progress on all referrals case management activities.
• Responsible for using standards of documentation and maintaining confidentiality as per Agency policy and procedure.
• Responsible for providing orientation to new providers and nursing staff on Patient Referral System standards and forms.
• Responsible for attending in-services and educational classes to maintain current knowledge and develop skills for effective case management practice.
• Responsible for attending monthly IPA, eConsult and other assigned meetings and reporting updates to the Referrals and Clinical Team.
• Responsible for active participation in the Agency’s Improving Organization Performance Program including the Quality Management, Safety, Emergency Preparedness and Infection Control Programs, and is responsible for the Joint Commission and IPA/HMO Standard Compliance of Patient Referral Utilization Review Services.
• Responsible for performing other related duties as assigned by the Director of Managed Care Services.

Requirements:

• Graduate from an accredited nursing program.
• Current LVN California State License. Minimum Two (2) years clinical experience in an ambulatory care facility.
• Case Management, Referrals and/or Managed Care experience preferred.
• Computer skills, including Microsoft programs and knowledge of Electronic Medical Records systems.
• Bilingual English/Spanish and familiarity with the Hispanic culture.
• Access to automobile with valid California driver’s license and state mandated automobile insurance

Job Type: Full-time

Pay: $22.22 - $30.68 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Supplemental schedule:

• Holidays

Weekly schedule:

• Monday to Friday

Work Location: One location

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