Medical Case Manager (LVN) Long Term Care

Job Description

We are looking for a dedicated Medical Case Manager (LVN) specializing in Long Term Care to join Sunshine Enterprise USA LLC. As a vital part of our team, you will be responsible for reviewing and processing requests for authorization and notification of medical services, utilizing established criteria and policies to ensure quality care for our clients.

Responsibilities

• Review and process requests for medical services following CalAIM and LTC guidelines.
• Work closely with health networks and providers to authorize necessary referrals.
• Document all interactions and update necessary systems promptly.
• Collaborate with the Long-Term Care manager on staff training needs.
• Meet productivity and quality standards consistently.

Requirements

• High School diploma or equivalent required.
• Current LVN license in California with at least 3 years of nursing experience.
• Prior experience as a Clinical Nurse Reviewer preferred.
• Strong knowledge of healthcare regulations and medical coding systems.
• Excellent communication and organizational skills.

Preferred Qualifications

• Managed care and concurrent review experience.
• Bilingual proficiency in English and one of the threshold languages.

Benefits

• Competitive salary ranging from $33,000 to $54,930 annually.
• Health, dental, vision, and life insurance coverage.
• 401(k) savings plan and recognition programs.
• Opportunity for career growth and development.