Case Manager
1 week ago
We are seeking a highly motivated Case Manager to join our team at Astrana Health. As a Case Manager, you will play a critical role in ensuring that our patients receive the highest quality of care in a cost-effective manner.
Key Responsibilities- Comply with Case Management Department's policies and procedures.
- Utilize Milliman Care Guidelines, CMS, Title 22 guidelines and criteria for appropriateness of transition of care for members in SNF, SA, ARU, LTAC setting.
- Collaborate with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission.
- Review 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.
- Attend/coordinate Case Management meetings on and off-site as necessary.
- Interact with providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements.
- 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.
- 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 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.
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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