LVN Case Manager (Utilization Review)

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.

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.