- Sunshine Enterprise USA LLC
- Orange, CA
- 03-09-2024
Job Description
Join Sunshine Enterprise USA LLC as a Medical Case Manager (LVN) in Long Term Care. In this role, you will be responsible for reviewing and processing medical service requests while ensuring adherence to CalAIM and LTC authorization and referral processes. Collaborate with health professionals, clinical facilities, and providers to deliver excellent member care.
Responsibilities
- Review and process medical service requests for CalAIM and LTC services.
- Verify and process CalAIM and LTC referrals using established protocols.
- Coordinate member care with health teams and providers.
- Ensure compliance with productivity and quality standards.
- Identify areas for staff training and maintain data resources.
Requirements
- High School diploma or equivalent.
- Current California LVN license.
- 3 years of nursing experience with 1 year as a Clinical Nurse Reviewer.
- Strong problem-solving and organizational skills.
Preferred Qualifications
- Managed care and concurrent review experience.
- Bilingual in English and one defined language.
Benefits
- Competitive pay and weekly paychecks.
- Health, dental, vision, and life insurance.
- 401(k) savings plan.
- Awards and recognition programs.