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Case Manager
3 months ago
Job Title: Case Manager
Department: Health Services - ICM
**About the Role**:
We are currently seeking a highly motivated Case Manager. This role will report to a Manager - Case Management and enable us to continue to scale in the healthcare industry, focusing on SNF, SA, ARU, LTAC level of care.
**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, CMS, Title 22 guidelines and criteria for appropriateness of transition of care for members in SNF, SA,ARU, LTAC setting.
- 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 accurate reporting of all 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, facilities 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
**Qualifications**:
- Active Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license in California
- Ability to commute to our Monterey Park, CA office
- Two (2) years of clinical experience as an LVN
- Skilled Nursing Facility experience a plus
**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
- Punctual, Creative, self-motivated.
- Professional appearance and conduct.
- Conceptual and “big picture” understanding.
- Able to function independently under time constraints.
- Willing to learn and develop new responsibilities and skills.
- Good organization, critical thinking and problem solving skills.
- Must be detail-oriented and able to work autonomously but also as a team member.
- Have experience in SNF case management
**Who We Are**:
- Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.
- Our platform currently empowers over 10,000 physicians to provide care for over 1.2 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
**Our Values**:
- Put Patients First_- Empower Entrepreneurial Provider and Care Teams_- Operate with Integrity & Excellence_- Be Innovative_- Work As One Team_
**Environmental Job Requirements and Working Conditions**:
- 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 at 1600 Corporate Center Drive., Monterey Park, CA 91754.-
- The total compensation target pay range for this role is: $28.00 - $35.00 per hour. The salary range represents our national target range for this role.-
**Additional Information**:
- #LI-Hybrid
