LVN Case Manager - Fresno 1.2

The Enhanced Care Management (ECM) Case Manager LVN will address the clinical and non-clinical needs of members with complex medical and social needs through coordination of services and comprehensive care management. The role involves in-person interactions with members, strong communication, and providing culturally appropriate and accessible communication. The position supports individuals experiencing homelessness, substance abuse, or behavioral health needs, and works with interdisciplinary teams to develop individualized care plans.

Requirements

• Effectively manage and maintain a caseload of assigned ECM members.
• Conduct a comprehensive assessment to develop a comprehensive, individualized, person-centered care plan.
• Ensure member’s care plan, incorporate identified needs and strategies to address needs, including physical and developmental health, mental health, dementia, SUD, LTSS, oral health, palliative care, necessary community-based and social services, and housing.
• Ensure the member is reassessed at a frequency appropriate for the member’s individual progress or changes in needs.
• Gather information, present, and participate in Interdisciplinary Care Team (ICT) meetings.
• Provide support to engage the member in their treatment, including coordination for medication review and/or reconciliation, scheduling appointments, providing appointment reminders, coordinating transportation, accompaniment to critical appointments, and identifying and helping to address other barriers to member engagement in treatment.
• Provide services, such as coaching, to encourage and support members to make lifestyle choices based on healthy behavior.
• Coordinate medication review/reconciliation and provide adherence support and referral to appropriate services.
• Determine appropriate services to meet the needs of members, including services that address SDOH needs, including housing, and services offered by Community Supports.
• Coordinate and refer members to available community resources and follow up with members (and or parent, caregiver, guardian) to ensure services were rendered (i.e., “closed loop referrals”).
• Work collaboratively and consult with other staff to achieve goals and remove barriers to member health.

Benefits

• Medical
• Dental
• Vision
• Simple IRA Plan
• Employer Paid Life Insurance
• Employee Assistance Program