Case Manager (LVN/RN)

Astrana Health, Inc.•Tustin, CA

8h•$34 - $48•Onsite

About The Position

We are currently seeking a highly motivated Case Manager. This role will report to the Supervisor – Inpatient Case Management and enable us to continue to scale in the healthcare industry. This is an on-site role where the expectation is to work at Foothill Regional Medical Center. Our Values: Put Patients First, Empower Entrepreneurial Provider and Care Teams, Operate with Integrity & Excellence, Be Innovative, Work As One Team.

Requirements

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
At least Two (2) years of clinical knowledge and experience as an LVN

Nice To Haves

Skilled Nursing Facility experience a plus
Excellent analytical critical reasoning
Proven ability to prioritize multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlines
Ability to educate and train staff members and other departments as needed
Experience using EZCAP
Strong communication and customer service skills
Punctual, Creative, self-motivated
Professional appearance and conduct
Conceptual and “big picture” understanding
Able to function independently under time constraints
Willing to learn and develop new responsibilities and skills
Good organization, critical thinking and problem solving skills
Must be detail-oriented and able to work autonomously but also as a team member
Have experience in SNF case management

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