Case Manager (LVN/RN) (On-Field - Orange County)

Astrana Health, Inc.•Monterey Park, CA

2d•$31 - $45•Hybrid

About The Position

Astrana Health is looking for a RN/LVN Case Manager who has the ability to commute to our Monterey Park office at 1600 Corporate Center Drive. This position works standard day hours M-F, and we are willing to train RN or LVN with no case management experience! You will have the ability to work with pediatrics and/or adult populations depending on business need. This is a field based position where the staff will need to visit admitted members at our partnered hospitals located in the Orange County area.

Requirements

Active Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license in California
Experience using Microsoft applications such as Word, Excel and Outlook
At least two (2) years of clinical experience as an LVN

Nice To Haves

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

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 criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge plan
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 daily accurate reporting of all inpatient 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
Conduct Hospital On-Site visits with members to ensure transition of care from hospital to lower level of care
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, 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
Other duties as assigned