Case Manager (LVN or RN)

Astrana Health Monterey Park, CA 91754, US

$31 - $45 / hour

Case Manager (LVN or RN)

Department: HS - ICM

Employment Type: Full Time

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Reporting To: Jade Oculam

Compensation: $31.00 - $45.00 / hour

Description

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 a 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.

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 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
Other duties as assigned

Qualifications

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

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

Environmental Job Requirements and Working Conditions

Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located in 1600 Corporate Center Dr., Monterey Park, CA 91754
The target pay range for this role is between $31.00 - $45.00 per hour. LVN license will fall between $31.00 - $38.00 and RN license will fall between $39.00 - $45.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on 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 based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com 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.

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