Case Manager

1 week ago

Monterey, California, United States Astrana Health Full time
About the Role

We are seeking a highly motivated Case Manager to join our team. This role will report to the Supervisor - Inpatient Case Management and enable us to continue to scale in the healthcare industry.

Key Responsibilities
  • 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
  • Bachelors' degree in Nursing, or LVN
  • 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
What We Offer

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 platform currently empowers over 12,000 physicians to provide care for over 1.3 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 in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

We are proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon 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.

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