Case Manager, LVN/RN
Astrana Health
full-time
Posted on:
Location Type: Hybrid
Location: Monterey Park • California • United States
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Salary
💰 $31 - $45 per hour
About the role
- 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
- 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
- Available for Hospital on site Case Management
- Other duties as assigned
Requirements
- 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
- 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
Benefits
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located in San Francisco and Daly City.
- This role also requires visiting patients in our partnered hospitals.
- Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical experiencemedical necessity determinationcare coordinationdischarge planningutilization managementcase managementanalytical reasoningcritical reasoningreportingproblem resolution
Soft Skills
communication skillscustomer service skillsability to prioritizeeducating stafftraining staffinterpersonal skillscollaborationadaptabilityorganizational skillsattention to detail
Certifications
Registered Nurse (RN) licenseLicensed Vocational Nurse (LVN) license