Medical Case Manager (LVN) Long Term Care

Job Description

We are looking for a dedicated Medical Case Manager (LVN) specializing in CalAIM and Long Term Care (LTC) to join Sunshine Enterprise USA LLC. In this role, you will review and process requests for medical services, providing authorization and referral services. Your responsibilities will include verifying medical necessity, coordinating member care, and maintaining quality standards. The ideal candidate will have strong problem-solving skills, the ability to work in a fast-paced environment, and effective communication abilities. If you are a licensed vocational nurse with experience in clinical nursing and a passion for providing high-quality care, we encourage you to apply.

Responsibilities

• Review and process requests for medical services.
• Verify medical necessity for CalAIM and LTC services.
• Coordinate member care with health networks and providers.
• Maintain productivity and quality of work standards.
• Assist in identifying staff training needs.

Requirements

• High School diploma or equivalent required.
• Current, unrestricted LVN license in the State of California.
• 3 years of nursing experience, with 1 year as a Clinical Nurse Reviewer.
• Managed care and concurrent review experience preferred.

Benefits

• Competitive pay & weekly paychecks.
• Health, dental, vision, and life insurance.
• 401(k) savings plan.
• Awards and recognition programs.