Case and Disease Manager LPN

CSTS is a third-party administrator that conducts the administrative and operational work for an insurance plan. The administrative work often includes processing claims, enrolling customers, collecting premiums, and complying with federal regulations. At CSTS we aim high. Our mission is to transform the healthcare experience — the way healthcare is accessed and delivered — by bringing outstanding products and services to our partners.

We’re looking for a compassionate LPN to support our Care Management and Disease Management programs. You’ll help members stay healthy and independent through advocacy, education, and coordination of services—working closely with RN case managers, physicians, and health plan partners. You’ll engage with a diverse population—from adults to seniors—and support members across various lines of business (Medicare, Medicaid, Duals, MA, etc.). This is a collaborative role where you’ll make a real impact on outcomes, costs, and quality of care.

Engage members by phone and in person to complete health risk screenings (e.g., HRA, fall risk) and gather info needed for care plans—following RN/clinical protocols. Support individualized care plans: identify barriers, set goals, track progress, and document outcomes—escalating complex needs to RN/Medical Director. Provide disease education and coaching (med adherence, chronic condition stability, patient safety) and share written materials per health plan service level agreements. Coordinate care: schedule appointments, facilitate preventive services, arrange referrals, and help prevent avoidable ER visits/readmissions. Document all contacts (successful/unsuccessful, mode of contact) accurately and timely in case management systems. Track program metrics (members identified/enrolled, goals met, duration, impact) and contribute to quality projects. Collaborate daily with PCP offices, specialists, care teams, and health plans; participate in Interdisciplinary Care Team (ICT) meetings. Assist with medication reviews (adherence, cost-effective alternatives, generics) and arrange Patient Assistance Programs (PAPs) when needed. Support delegated CM/DM requirements and payer initiatives (e.g., CMS Stars, HEDIS, patient safety). Use case management tools (InterQual® Care Enhance Review Manager Enterprise—CERME preferred) and maintain HIPAA compliance. Refer complex cases to RN case managers and corporate Medical Directors.