Lead LVN Case Management (HE)

Under the direction of the Manager of Health Education, this position is responsible for assisting in the development and improvement of disease management programs to ensure the efficacy of patient education and case management services offered in the Health Education Department. This position will train case management staff; act as a resource for case management staff; and will ensure adequate coverage for case management staff, as needed. The Lead LVN Case Manager position will work on an interdisciplinary team to facilitate and coordinate the patient's plan of care with the provider and will be responsible for providing assessment, patient counseling/education, and care plan reinforcement. The Lead LVN Case Manager will teach health education classes and carry out disease management initiatives as assigned. The Lead LVN Case Manager will interact with other departments, clinic personnel, and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.

• Functions as a health educator and resource person for the Health Education Department.
• Provide Health Education Case Managers with guidance, direction, leadership, and support necessary to ensure that they can accomplish goals set for them.
• Consults with Health Education Case Managers on difficult cases and provides a second opinion, expertise, and assistance solving complex problems.
• Monitors disease management clinic activity and case loads of Health Education Case Managers to ensure efficient and effective patient care.
• Provides leadership and policy interpretation to the unit as directed.
• Evaluates hospital and ER admissions and assesses whether visits were preventable or not preventable. Tracks each Health Education Case Manager's trends.
• Trains new Case Managers in Health Education and completes a competency check list for all new hires. Communicates with Manager of Health Education on new employee's status.
• Ensures coverage for Health Education Case Managers on PTO, who have called out, or who need assistance with appointment coverage.
• Communicate with healthcare providers or with managers of other departments regarding any problems with outpatient services.
• Plan, organize, coordinate, implement and monitor, along with the Manager of Health Education, the Disease Management Program to better serve our patients. Take an active role in streamlining said processes.
• Assist with updating Disease Management Membership statuses when needed i.e., admissions, discharges, acuity level changes.
• Assist with patient problems as assigned by the Manager of Health Education, SVP, UR team or Customer Service department.
• Be knowledgeable regarding disease processes and medications to ensure the ability to assess patient needs and provide education as needed.
• Teach health education classes and programs (diabetes, CHF, pre-surgery joint, advance health care directive, smoking cessation, slip and fall prevention) as assigned.
• Know and understand criteria for various disease management programs and be able to educate patient on these programs.
• Identify and outreach to members eligible for enrollment in health education programs.
• Communicate with patient and document contact in NextGen.
• Mobilizes resources and intervenes as needed to achieve expected goals to assist in achieving desired clinical outcomes within desired timeframe.
• Dispense diabetic testing supplies and provide glucometer instruction for various devices.
• Conduct assessment to include patient's clinical history, self-reported health status and goal, care plans with goals and barriers with progress towards goals, medication reconciliation, social history, caregiver resources, hearing and vision, available benefits, community resources, interdisciplinary care team members, next scheduled follow up, health screenings, and life planning activities.
• Obtain and document all pertinent patient information in NextGen.
• Strive for a positive and professional relationship with providers, patients, and families.
• Create a comprehensive and working care plan following NCQA, CMS, & Health Plan guidelines, with input from the care team and patient or caregiver.
• Update care plan accordingly.
• Efficiently capture HEDIS/CMS Star Quality Measures on each visit/during each phone call.
• Coordinate the provision of Social Services with the assistance of the Patient Services Coordinator for patients and families to enable them to cope with the impact of illness on an individual family functioning and to achieve maximum benefits from health care services.
• Strive for timely admissions and discharges from the Disease Management Program.
• Ensure a smooth transition of care back to Primary Care Provider after discharge from Health Education programs.
• Facilitate any transitional care needs and ensure follow-through on all orders.
• Initiate/participate in Code Red, Code White and Code Blue situations as needed.
• Understand patient healthcare benefits and help establish expectations for services within those benefit limits.
• Assist with Health Education and Disease Management Program schedules as needed.
• Participate in the Utilization Review process regarding any assigned patients and ensure proper hand off reporting to the UR Case Manager.
• All other job duties as assigned.

8.1 Valid Nursing license in the state of California, Licensed Vocational Nurse.

8.2 Minimum of four or more years clinical nursing experience.

8.3 2 years' experience in Case Management.

8.4 Experience with Managed Care preferred.

8.5 Must have current BLS certification.

The pay range for this position at commencement of employment is expected to be between $34.84- $40.99. However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.