Astrana Health, Inc.
Location
Monterey Park, California
Salary
$31 - $45 / HOUR
The Case Manager is responsible for coordinating patient care, performing utilization reviews, and establishing discharge plans in collaboration with hospital staff. They must ensure compliance with health plan standards and maintain accurate reporting of inpatient admissions.
Candidates must hold an active California RN or LVN license and possess at least two years of clinical experience. Proficiency in Microsoft Office applications and strong analytical and communication skills are required for this role.
Description Astrana Health is looking for a RN/LVN Case Manager who has the ability to commute to our Monterey Park office at 1600 Corporate Center Drive. This position works standard day hours M-F, and we are willing to train a RN or LVN with no case management experience! You will have the ability to work with pediatrics and/or adult populations depending on business need.
What You'll Do Comply with Case Management Department’s policies and procedures 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management Utilize Milliman Care Guidelines criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge plan Collaborating with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission Responsible for coordinating the required initial and concurrent reviews based on the review of medical records received and daily accurate reporting of all inpatient admissions to Medical Director and Manager and/ or Supervisor of Case Management Department Review of medical records and/or other documentation to determine medical necessity, appropriateness and level of care utilizing Milliman Care and other appropriate Guidelines Assess, plan, implement, coordinate, monitor, and evaluate all options and services with the goal of reducing hospital readmission Attends/coordinates Case Management meetings on and off-site as necessary Conduct Hospital On-Site visits with members to ensure transition of care from hospital to lower level of care Interacts with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements Attend to provider and interdepartmental calls in accordance with exceptional customer service Maintain good relationships with health plans, hospitals and medical directors. Resolve problems that arise with any IPA medical directors Report to Manager and/or Supervisor of Case Management on activities and/or problems occurring throughout the day Other duties as assigned
Active Registered Nurse (RN) license in California OR active Licensed Vocational Nurse (LVN) license in California Experience using Microsoft applications such as Word, Excel and Outlook At least two (2) years of clinical experience as an RN/LVN You're great for this role if: Excellent analytical critical reasoning Proven ability to prioritize multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlines Ability to educate and train staff members and other departments as needed Experience using EZCAP Strong communication and customer service skills
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
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