Medical Case Manager (LVN) Long Term Care

Job Description

Company Overview: Sunshine Enterprise USA LLC is an industry-leading staffing and recruitment firm working with fortune 500 companies, start-ups, government, private equity firms, and professional services firms. We value creativity, diversity, and growth in our work environment, making it a rewarding place for employees.

Job Summary: The Medical Case Manager (LVN) in CalAIM and Long Term Care (LTC) will review and process authorization requests for medical services. This role involves interacting with health professionals, clinical facilities, and ancillary providers, authorizing referral requests based on medical criteria and established procedures.

Position Responsibilities:

• Review requests for medical appropriateness for CalAIM and LTC services.
• Process referrals via Health Connect, telephone, or fax using clinical protocols.
• Coordinate member care with health teams and providers.
• Ensure productivity and quality standards are met.

Possesses the Ability To:

• Demonstrate problem-solving and organizational skills in a fast-paced environment.
• Communicate effectively and maintain relationships with staff.
• Use computer software for documentation and reporting.

Experience & Education:

• High School diploma or equivalent.
• Current LVN license in California.
• 3 years of nursing experience, including 1 year as a Clinical Nurse Reviewer.

Preferred Qualifications:

• Managed care and concurrent review experience.
• Bilingual skills in English and another defined language.

Knowledge of:

• Utilization management guidelines and regulations.
• Medical Terminology and coding systems.
• Medi-Cal and Medicare benefits.
• Healthcare administration principles.

Join Sunshine Enterprise USA LLC and enjoy competitive pay, health benefits, 401(k) savings, and more. We are an Equal Opportunity Employer.

Compensation Details:

$33,000-$54,930 yearly salary