Case Manager II (RN or LVN)

Astrana Health, Inc.•Monterey Park, CA

10d•$35 - $45•Hybrid

About The Position

The Case Manager II is an experienced clinical case management professional who independently manages a complex caseload across acute inpatient and post-acute settings. The role combines concurrent clinical review, discharge and transition-of-care planning, direct Member and family engagement, and coordination with hospitals, skilled nursing facilities (SNFs), Hospitalists, primary care providers, specialists, health plans, and internal clinical teams. The Case Manager applies clinical judgment to identify barriers and high-risk needs and coordinate services that support safe transitions, reduce avoidable utilization and readmissions, and improve continuity of care. The role is expected to demonstrate independence and ownership of complex cases and escalations, and contribute to market- and department-level initiatives. The position works in a hybrid structure, with work both onsite and at home each week. It includes visiting patients at partnered hospitals two to three times per week. The home office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754. Compensation is $35.00–$45.00 per hour, with the LVN range listed as $35.00–$38.00 and the RN range as $39.00–$45.00. Actual compensation depends on factors including geographic location, experience, and other job-related factors.

Requirements

Active Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license in the applicable state, in good standing.
Minimum two years of clinical experience as an RN/LVN.
Demonstrated experience in Case Management, Utilization Management, acute care, post-acute care, or a related clinical setting.
Strong clinical assessment, critical thinking, prioritization, and problem-solving skills.
Ability to independently manage multiple responsibilities in a fast-paced, changing environment while meeting required timelines.
Strong written and verbal communication skills and demonstrated ability to collaborate effectively with Members, families, providers, facilities, and interdisciplinary teams.
Proficiency with Microsoft Word, Excel, Outlook, and other standard business applications.

Nice To Haves

Experience with delegated health plan Case Management and/or Utilization Management.
Experience managing acute inpatient and SNF/post-acute populations.
Experience conducting onsite or field-based Case Management.
Knowledge of MCG or other nationally recognized clinical guidelines.
Experience with EZ-CAP, AYCE, or comparable care management/utilization management platforms.
Demonstrated ability to educate, mentor, and support staff or cross-functional teams.
Experience supporting new market development, provider/facility collaboration, or workflow implementation.

Responsibilities

Comply with Case Management, Utilization Management, health plan delegation, regulatory, and accreditation requirements applicable to assigned responsibilities.
Independently manage a complex mixed caseload across acute inpatient, SNF, rehabilitation, and other post-acute settings, with timely follow-up and accurate documentation.
Review medical records and other clinical documentation to assess medical necessity, appropriateness, level of care, skilled needs, and transition-of-care needs using MCG and other applicable criteria and guidelines.
Coordinate required initial and concurrent clinical reviews and communicate relevant findings, barriers, and escalations to the Medical Director and Case Management leadership as appropriate.
Collaborate with Hospitalists, facility Case Managers, discharge planners, PCPs, specialists, Members, families, and other care partners to establish and advance safe discharge plans as early as possible in the admission.
Assess, plan, implement, coordinate, monitor, and evaluate care management interventions to support appropriate utilization, continuity of care, and reduction of avoidable ER utilization and hospital readmissions.
Conduct direct Member and family outreach to provide education, identify barriers, support discharge planning, and promote engagement in the transition-of-care plan.
If designated, conduct onsite hospital and/or SNF visits, as assigned, to support Member engagement, facility collaboration, transition planning, and progression to the most appropriate level of care.
Facilitate PCP and specialty follow-up and coordinate referrals to Population Health, Care at Home, disease management, high-risk care management, and other internal or community programs when appropriate.
Identify high-risk Members, repeat utilizers, care gaps, and social or clinical barriers and coordinate appropriate interventions and escalation.
Build and maintain collaborative relationships with health plans, hospitals, SNFs, Hospitalists, Medical Directors, provider offices, and other network partners.
Communicate determinations and care coordination outcomes to providers and/or Members, as applicable, in accordance with state, federal, health plan, and accreditation requirements.
Participate in Case Management rounds, facility meetings, network discussions, and performance-improvement initiatives on and off site as needed.
Support implementation and refinement of Case Management workflows, particularly in developing or expanding markets, and serve as a clinical/operational resource to internal teams and external partners.
Provide education, workflow support, and informal mentorship to Case Manager I staff and other team members as appropriate.
Escalate complex clinical, operational, access, or provider issues appropriately and partner with leadership to drive resolution.
Maintain timely, accurate, and complete documentation and reporting of Case Management activities, Member engagement, referrals, appointments, and identified barriers.
Perform other duties and responsibilities as assigned consistent with the scope and level of the position.