Case Manager

4 semanas atrás

Nova Iguaçu, Rio de Janeiro, Brasil Astrana Health Tempo inteiro

Join to apply for the Case Manager role at Astrana Health

Join to apply for the Case Manager role at Astrana Health

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Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Compensation: $32.00 - $40.00 / hour

Department: HS - ICM

Location: 600 City Parkway West 10th Floor, Orange, CA 92868

Compensation: $32.00 - $40.00 / hour

Description

Job Title: Case Manager - LVN/RN
Department: Health Services - ICM

About the Role:
Astrana Health is looking for an LVN or RN Case Manager with at least 1-2 years of acute nursing experience and/ or Inpatient 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 Inpatient Case Management
  • Utilize Milliman Care Guidelines (MCG) 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 daily 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

Qualifications
  • Active Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license in California
  • Has at least 1-2 years of acute nursing experience and/ or Inpatient case management experience
  • Experience using Microsoft applications such as Word, Excel, Outlook and Teams
  • Able to work 8am-5pm PST
You're great for this role if:
  • Has both acute nursing experience and Inpatient case management experience
  • 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 Essette, IDX and EZCAP
  • Strong communication and customer service skills

Environmental Job Requirements and Working Conditions
  • This is a remote role. The home office is aligned with your department at 600 City Parkway West, 10th Floor, Orange, CA 92868.
  • The total compensation target pay range for this role is $32.00 - $40.00 per hour. The salary range represents our national target range for this role.
Seniority level
  • Seniority levelAssociate
Employment type
  • Employment typeFull-time
Job function
  • Job functionOther
  • IndustriesHospitals and Health Care

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