Clinical Case Manager

4 weeks ago


Monterey, California, United States Astrana Health Full time

About the Role:

We are seeking a highly motivated Clinical Case Manager to join our team. As a Clinical Case Manager, you will play a critical role in ensuring the best possible outcomes for our patients. Your primary responsibility will be to coordinate and manage the care of patients with complex medical needs, working closely with healthcare providers, hospitals, and other stakeholders to ensure seamless transitions of care.

Key Responsibilities:

  • Comply with Case Management Department's policies and procedures.
  • Collaborate 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.

Requirements:

  • Active Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license in California.
  • Ability to commute to our Monterey Park, CA office.
  • Experience using Microsoft applications such as Word, Excel and Outlook.
  • Two (2) years of clinical experience as an LVN.
  • Skilled Nursing Facility experience a plus.

Astrana Health:

Astrana Health 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 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.



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