Case Manager

4 weeks ago

Monterey Park, United States Astrana Health Full time

Department: HS - ICMLocation: 1600 Corporate Center Dr., Monterey Park, CA 91754Compensation: $31.00 - $45.00 / hourDescriptionAstrana is looking for a RN/LVN Case Manager 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.Our Values:Put Patients FirstEmpower Entrepreneurial Provider and Care TeamsOperate with Integrity & ExcellenceBe InnovativeWork As One TeamWhat You'll DoComply with Case Management Department’s policies and procedures95 - 100% compliance with Utilization Management health plan delegation standards for Case ManagementUtilize Milliman Care Guidelines criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge planCollaborating with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admissionResponsible 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 DepartmentReview of medical records and/or other documentation to determine medical necessity, appropriateness and level of care utilizing Milliman Care and other appropriate GuidelinesAssess, 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 necessaryInteracts with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirementsAttend to provider and interdepartmental calls in accordance with exceptional customer serviceMaintain good relationships with health plans, hospitals and medical directors. Resolve problems that arise with any IPA medical directorsReport to Manager and/or Supervisor of Case Management on activities and/or problems occurring throughout the dayAvailable for Hospital on site Case ManagementOther duties as assignedQualificationsActive Registered Nurse (RN) license in California OR active Licensed Vocational Nurse (LVN) license in CaliforniaExperience using Microsoft applications such as Word, Excel and OutlookAt least two (2) years of clinical experience as an RN/LVNYou're great for this role if:Excellent analytical critical reasoningProven ability to prioritize multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlinesAbility to educate and train staff members and other departments as neededExperience using EZCAPStrong communication and customer service skillsEnvironmental Job Requirements and Working ConditionsOur organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The position is located at 1600 Corporate Center Dr, Monterey Park, CA 91754.This role will require visiting patients in our partnered hospitals.The target pay range for this role is between $31.00 - $45.00per hour. The salary range represents our national target range for this role.

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