The Role
On-site inpatient case manager (LVN/RN) coordinating utilization reviews, discharge planning, and transitions of care using Milliman/CMS/Title 22 guidelines to reduce readmissions and ensure compliance with health plan standards.
Summary Generated by Built In
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
What You'll Do
- 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
Qualifications
- 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
- Skilled Nursing Facility experience a plus
You're great for this role if:
- 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
Environmental Job Requirements and Working Conditions
Astrana Health is proud to be 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. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
About
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Skills Required
- Bachelor's degree in Nursing or LVN
- Active LVN or RN license in California
- At least two (2) years clinical experience as an LVN
- Ability to commute to Monterey Park, CA (Foothill Regional Medical Center)
- Experience using Microsoft Word, Excel and Outlook
- Familiarity with Milliman Care Guidelines, CMS and Title 22 utilization criteria
- Skilled Nursing Facility (SNF) case management experience
- Experience using EZCAP
- Strong communication, customer service, organization, and critical thinking skills
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The Company
What We Do
Astrana Health is a physician-centric, technology-powered healthcare company that operates an integrated delivery platform. It enables providers to participate in value-based care arrangements, helping them deliver accessible, high-quality, and cost-effective care to patients. The company provides care coordination services to patients, primary care physicians, specialists, and health plans, leveraging proprietary technology to streamline operations and improve patient outcomes across local communities.
