Temporary Medical Case Manager (LVN) CalAIM
Location: Orange County, CA
Job Type: Temporary / Contract
Assignment Duration: Up to 6 months
Schedule: Monday Friday, 8:00 AM 5:00 PM
Work Arrangement: Fully Onsite
About the Role
We are seeking an experienced Licensed Vocational Nurse (LVN) to join our CalAIM team as a Temporary Medical Case Manager. This position supports care coordination and utilization management activities for CalAIM services, ensuring requests are reviewed appropriately and members receive timely, high-quality support.
The ideal candidate will have strong clinical judgment, excellent communication skills, and the ability to work independently in a fast-paced healthcare environment. Experience with managed care or authorization review is highly preferred.
Key Responsibilities
Review authorization requests for CalAIM services for medical appropriateness using established clinical criteria, policies, and procedures.
Verify and process CalAIM referrals received through healthcare systems, telephone, and fax.
Apply established clinical protocols to determine medical necessity.
Coordinate member care with health networks, healthcare providers, internal teams, patients, and families.
Accurately document authorization decisions, clinical information, and updates in utilization management or care management systems.
Determine the appropriate action for requested services, including approval, modification, or denial.
Refer cases to the Medical Director for review when appropriate.
Contact members, families, and CalAIM providers to obtain additional information as needed.
Support department goals and priorities while maintaining a member-focused, mission-driven approach.
Meet established productivity, quality, documentation, and performance standards.
Collaborate effectively with internal departments and external healthcare partners.
Perform other duties and projects as assigned.
Required Qualifications:
Current, unrestricted California LVN license required.
High school diploma or equivalent.
At least 3 years of nursing experience.
Strong clinical judgment and problem-solving skills.
Excellent verbal and written communication abilities.
Ability to work independently and manage multiple priorities.
Proficiency with Microsoft Office applications, including Word, Outlook, Excel, and PowerPoint.
Ability to work effectively in a fast-paced environment.
Preferred Qualifications:
Experience in managed care.
At least 1 year of authorization review experience.
Experience with utilization management, care management, or medical necessity review.
Bilingual in English and one of the following threshold languages: Arabic, Farsi, Chinese, Korean, Spanish, or Vietnamese.
Thanks & Regards,
Amit Singh
Sr. Recruiter
Direct: 510-972-5969
#OR2026
Medical Case Manager (LVN) at Orange, CA • Orange, CA, United States
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