Case Manager, LPN
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Job Description
Case Manager – LPN providing clinical and operational support in Medicare Advantage Programs. Collaborating with interdisciplinary teams to ensure high-quality, coordinated care for members.
Responsibilities:
- Provide both clinical and operational support through data collection, care coordination activities, provider and vendor communication, timely report distribution, and day‑to‑day assistance to team experts and leadership.
- Support member outreach, referrals, appointment scheduling, and accurate documentation to ensure efficient, compliant care coordination.
- Initiate referrals and support care coordination workflows by gathering clinical, functional, and social information needed for RN led case assessment and service planning, following established case management procedures.
- Perform structured case management support activities (e.g., follow up calls, resource coordination, appointment scheduling, and preparation of case summaries) using predefined tools and templates, escalating any findings that require RN/Medical Director interpretation.
- Communicate with members, providers, caregivers, and internal teams regarding required documentation, service logistics, resource connections, and case status, using approved scripts and escalation pathways.
- Participate in quality improvement, compliance activities, and competency requirements tied to case management program standards.
Requirements:
- License Licensed Practical Nurse (LPN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
- 1-2 years - Clinical experience required.
- Knowledge of community resources, benefits, and service authorization processes.
- Familiarity with care management frameworks and regulatory requirements.
- High attention to detail with the ability to document accurately and meet regulatory standards (NCQA, URAC, CMS).
Benefits:
- Various immunizations and/or associated medical tests may be required for this position.
- Digital literacy assessment required.
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