Case Manager (LVN/RN)

About the role

Astrana Health is seeking a RN/LVN Case Manager to join their team. This position offers standard day hours Monday through Friday and is open to training individuals with no prior case management experience.

Responsibilities

• Comply with Case Management Department’s policies and procedures
• Utilize Milliman Care Guidelines criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge plan
• Collaborate with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission
• Coordinate required initial and concurrent reviews based on medical records received and daily accurate reporting to Medical Director and Manager and/or Supervisor of Case Management Department
• 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
• Attend provider and interdepartmental calls in accordance with exceptional customer service
• Maintain good relationships with health plans, hospitals, 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
• Available for Hospital on-site Case Management field work throughout the week, visiting hospitals and engaging with members who are admitted to the hospitals
• Other duties as assigned

Qualifications

• Active Registered Nurse (RN) license in California OR active Licensed Vocational Nurse (LVN) license in California
• Experience using Microsoft applications such as Word, Excel, and Outlook
• At least two (2) years of clinical experience as an RN/LVN
• You're great for this role if:
• Excellent analytical critical reasoning
• Prior proven ability to prioritize multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlines
• Proven ability to educate and train staff members and other departments as needed
• Experience using EZCAP
• Strong communication and customer service skills

Environmental Job Requirements and Working Conditions

This role requires working both onsite and at home on a weekly basis. The home office is located at 1600 Corporate Center Dr, Monterey Park, CA 91754. The position involves visiting patients in partnered hospitals 2-3 times a week. The national target pay range for this role is between $31.00 - $45.00 (LVN - $31.00-38.00; RN - $39.00-45.00) per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is committed to providing equal employment opportunities and is 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. All employment is decided on the basis of qualifications, merit, and business need.