Case Manager (LVN or RN) - Pediatric/ CCS
About the position Astrana is looking for a RN/LVN Case Manager 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. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team
Responsibilities
- Comply with Case Management Department’s policies and procedures
- Achieve 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
- Collaborate 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
- Attend/coordinate 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
- Interact 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
Requirements
- Active Registered Nurse (RN) license in California OR active Licensed Vocational Nurse (LVN) license in California
- Ability to commute to our Monterey Park, CA office
- Experience using Microsoft applications such as Word, Excel and Outlook
- Two (2) years of clinical experience as an RN/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
Benefits
- We are willing to train a RN or LVN with no case management experience
- Ability to work with pediatrics and/or adult populations depending on business need
- Hybrid work structure
- 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 conditioos), 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.