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Job Title: LVN Case Manager

Job Description

As a part of the Utilization Management team, the LVN Case Manager is a member of the Care Coordination team. The LVN Case Manager will perform initial review, concurrent review, and discharge planning in conjunction with the case management team. The Case Manager must know CMS criteria & MCG criteria, as each plan has different criteria. Case volume varies each day based on complexity and type. The minimum expectation is to process 15-25 cases per day (e.g., 7 initial review, 10 follow-up/concurrent review, 5 discharge). These are in-patient cases.

• Plan for and ensure that all post-discharge care is coordinated appropriately according to the needs of the patient and ensure continuity of care.

• Conduct inpatient and skilled nursing facility level of care review on a concurrent basis.

• Plan for and coordinate all discharges from inpatient and skilled nursing facilities.

• Make outbound calls to the case management team to follow up on cases.

• Track barriers to appropriate inpatient and SNF utilization according to policy and procedure.

• Attend Utilization Management and/or Quality Management meetings as needed.

• Appropriately change patient's case management status to complex case management or to routine case management based on assessment of patient's medical status changes and progression of goals utilizing complex/routine case management criteria.

Hard Skills

• Milliman Criteria Guidelines

• Utilization Management

• Inpatient

Job Type

This is a contract position with a duration of 6 Month(s).

Work Site

This is a fully remote position.

Work Environment

Monday-Friday 8am-5pm (1 hour lunch). Some holidays and weekends (this isn't currently a need, but the hiring manager wants to know if they are willing to support if necessary). Remote environment.

For immediate consideration, email your updated resume to ryreyes@ actalentservices.com along with a couple of reasons why you're a strong fit for the role.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent

• Maintaining an inclusive environment through persistent self-reflection

• Building a culture of care, engagement, and recognition with clear outcomes

• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com) for other accommodation options.