Responsible for health care management and coordination within the scope of licensure for members with short term chronic care needs based on care plan provided by providers implementing, coordinating, monitoring care plans designed to optimize member health care across the care continuum. Coordinates and monitors Alignment Healthcare member's progress and services to ensure consistent cost effective care that complies with Alignment policy and all state and federal regulations and guidelines. Performs duties mostly telephonically.

General Duties/Responsibilities (May include but are not limited to):

• Ensures member access to services appropriate to their health needs.
• Identifies, assesses and manages members per established criteria.
• Review and implement care plan and provide education materials as necessary with members.
• Interfaces with Primary Care Physicians, Nurse Practitioners, RN case managers and specialists for coordination of care for members.
• Assists in problem solving with providers, RN case managers or service issues.
• Measures the effectiveness of interventions to determine case management referrals and outcomes.
• Participates and provides feedback in the development of utilization/care management policies and procedures.
• Counsels and engages in personal discussions with patients and their families on available care options. Helps them to determine their appropriate and preferred course of action.
• Providing follow up and implement care plan based on Nurse Practitioner

SUPERVISORY RESPONSIBILITIES:

None

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

5 years of clinical case management experience; or any combination of education and experience, which would provide an equivalent background.

Education/Licensure:

Current, unrestricted LVN license in the state for which you are applying

Associate degree preferred

Other:

N/A

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $70,823.00 - $106,234.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.