Remote Rn Field Case Manager Jobs in Riverside, CA

Description

JOB SUMMARY

The Internal Audit Management LVN supports the oversight and monitoring of Utilization Management and Case Management delegated functions of contracted medical groups to ensure regulatory, accreditation, and health plan compliance. This role assists with internal reviews of UM and CM workflows, internal auditing and corrective action follow-up, letter accuracy to members and providers, and UM and CM process standardization. The LVN collaborates with Medical Management leadership, IT, analytics, and external partners to help maintain compliant, timely, and accurate operational performance. 

Requirements

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

Minimum: Graduate of an accredited Licensed Vocational Nurse program.

Preferred: Coursework or training in quality management, managed care, compliance, or healthcare administration.

Experience     

Minimum: 10+ years of experience in Delegation Oversight, Medical Management, Utilization Management, Quality Management. Prior supervisory or leadership experience.

Preferred: Experience with HEDIS or quality performance measures. Experience in system testing, change control, or IT partnership environments. Advanced experience in reporting tools (SQL/BI), Excel, or healthcare analytics.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position. 

Certification(s)

Current State LVN License

Preferred: Certified Professional in Healthcare Quality (CPHQ), Certified Case Manager (CCM), and/or Project Management Certification (CAPM/PMP).

Skills, Knowledge & Abilities

Knowledge of delegated functions, compliance standards, and health plan reporting requirements. 

Strong attention to detail and accuracy in documentation and letter review. 

Ability to interpret guidelines and apply them within LVN scope to operational processes. 

Proficiency in medical terminology, documentation standards, and regulatory timeframes. 

Strong communication, teamwork, and stakeholder support skills. 

Ability to coordinate tasks and support staff without independent clinical decision-making authority. 

Competence in Microsoft Excel, reporting tools, and electronic workflows.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. This position involves prolonged computer-based work requiring frequent use of a keyboard and mouse, along with regular walking, standing, bending, and the ability to lift or move up to 25 pounds. It occasionally requires stooping, kneeling, crouching, or crawling. The role demands strong visual capability-including close, distance, color, peripheral vision, depth perception, and focus adjustment-and the ability to concentrate for extended periods while managing interruptions and meeting deadlines. Work is primarily remote but may involve travel for meetings or oversight activities.

PAY RANGE

$35.00 - $40.00 / hourly