This position requires the full understanding and active participation in fulfilling the Mission of SGVMC. It is expected that the employee demonstrate behavior consistent with the Core Values. The employee shall support SGVMC’s strategic plan and the goals and direction of the performance Improvement Plan (PIP).

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

1. Discharge planning to occur with patient and family within two working days of admission and relay information to UR Staff.
2. Completes Initial Case Management Assessment form within first working day after admission.
3. Evaluates for appropriate level of Case utilizing Intensity of Service/Severity of Illness; InterQual criteria.
4. Communicate with Admitting Physician regarding appropriateness of level of Care as needed.
5. Complete concurrent review in Meditech daily on insurance, non-funded & MediCal patients, every other day for Medicare patients.
6. Meet with patient and family to discuss discharge plan.
7. Document initial evaluation and preliminary discharge plan in progress notes.
8. Provide clinical review to payors within 1 business day.
9. Arranges and documents post-hospital discharge needs such as SNF, ECF, LTAC, ARU, DME and home health. Prepares summarized clinical report on all assigned patients to present to weekly highcost/UR meeting.
10. Collaborates with staff nurse to address all discharge needs including medication education and discharge plans answering all questions before the patient leaves the hospital.
11. Discharge Planning, concur with Patient and family within two working days of admission and relay information to Case Manage or Social Worker whom need to evaluate information.
12. Other duties as required.

Education/Training/Experience:

• Minimum 1 year of case management or utilization review experience required.
• Two years recent acute clinical experience preferred
• ER experience is strongly preferred
• Knowledgeable about legal principles of consent, healthcare proxies and advance medical directives
• Knowledge of healthcare payor systems and benefits: HMO, PPO, Worker s Comp, Medicare guidelines and Medi-cal
• Strong leadership ability, independent thinking and decision-making ability; analytical problem solving skills, sound judgment; excellent oral and written communication skills, must be able to function in a team environment
• Proficient computer skills (MS Word, Excel, Outlook) 10. Excellent customer service skills required
• Ability to multi-task and prioritize assignments
• Ability to understand and react effectively in a high-paced environment
• Bilingual is a plus

 Licenses/Certifications

• Current LVN License must be active and unrestricted for the State of California
• Current BLS certification required
• Case Management Certification is a plus