CA license)

Astrana Health, Inc.•Orange, CA

3h•$50 - $60•Remote

About The Position

The Inpatient Case Manager RN coordinates patient care throughout the hospital stay to ensure safe, timely, and effective transitions of care. This role collaborates with physicians and interdisciplinary teams to assess patient needs, develop discharge plans, and facilitate appropriate use of healthcare resources while advocating for optimal patient outcomes.

Requirements

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.
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, 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
Other duties as assigned