Medica Talent Group
LVN Case Manager (Utilization Review)
Company Description
Job Description
Job Title: LVN Case Manager (Utilization Review) Location: Remote Schedule: Monday – Friday, 8:00 AM – 5:00 PM Pay Rate: $33 – $45 per hour Job Type: Temporary Assignment Overview: We are seeking an experienced LVN Case Manager to support care coordination and utilization review for patients admitted to hospitals and Skilled Nursing Facilities (SNFs). This role works closely with an interdisciplinary care team to manage patient care across the continuum, ensure appropriate level of care, and facilitate safe and timely discharges. The position is fully remote and requires strong inpatient utilization review and care coordination experience.
Requirements
Graduate of an accredited LVN nursing program. Active California Licensed Vocational Nurse (LVN) license. BLS certification (American Heart Association or American Red Cross). Minimum 3 years of clinical experience in public health, acute care, case management, or home health. At least 2 years of managed care case management experience with a focus on inpatient utilization review and/or ambulatory care. Experience working within a multidisciplinary care team. Bilingual English/Spanish preferred. Experience working with geriatric or medically complex populations preferred. Skills & Knowledge: Strong knowledge of utilization review, case management processes, and discharge planning. Understanding of managed care regulations, health plan requirements, and community resources. Excellent communication, critical thinking, and problem-solving skills. Ability to prioritize, multitask, and manage cases efficiently in a fast-paced environment. Proficiency with computer systems and medical documentation. Work Environment: Fully remote position supporting hospital and SNF care coordination. Works as part of a collaborative care team including RN Case Managers, social workers, and care coordinators. Ideal Candidate: A self-sufficient LVN with strong inpatient utilization review and care coordination experience who can quickly integrate into the team with minimal training.
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Responsibilities
Conduct daily concurrent and retro utilization reviews for hospitalized and SNF patients using evidence-based criteria (e.g., InterQual). Coordinate care and discharge planning to ensure appropriate level of care and prevent avoidable readmissions. Collaborate with hospitalists, Regional Medical Directors, social workers, ambulatory case management, and hospital nursing staff. Review and process pre-certifications, prior authorizations, and referral authorizations within required turnaround times. Identify California Children’s Services (CCS) cases, manage patient transfers, and support ambulatory case management enrollment when appropriate. Coordinate support services such as home health, durable medical equipment (DME), and follow-up PCP appointments. Conduct telephonic outreach to patients, providers, and caregivers to support care transitions. Participate in interdisciplinary rounds, discharge planning discussions, and care coordination meetings.
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