Case Manager - Home Health/Hospice (LVN/RN)

$62,400 - $93,600/Yr

Astrana Health - Monterey Park, CA

Full-time - Mid Level

Hybrid - Monterey Park, CA

5,001-10,000 employees

About the position

The Case Manager - Home Health/Hospice (LVN/RN) position at Astrana Health is a temporary role focused on providing high-quality case management services in a hybrid work environment. The Case Manager will report to the Supervisor of Inpatient Case Management and will play a crucial role in coordinating care for patients transitioning from skilled nursing facilities and other settings, ensuring compliance with health plan standards and improving patient outcomes.

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, CMS, Title 22 guidelines for transition of care appropriateness
• Collaborate with Hospitalists, case managers, and discharge planners to establish discharge plans at admission
• Coordinate initial and concurrent reviews based on medical records and report admissions to Medical Director and Manager/Supervisor
• Review medical records to determine medical necessity and appropriateness of care
• Assess, plan, implement, coordinate, monitor, and evaluate options and services to reduce hospital readmission
• Attend/coordinate Case Management meetings on and off-site as necessary
• Interact with providers or members to communicate determination outcomes
• Attend to provider and interdepartmental calls with exceptional customer service
• Maintain relationships with health plans, facilities, and medical directors
• Report to Manager/Supervisor on daily activities and problems

Requirements

• Bachelor's degree in Nursing or active LVN/RN license in California
• Ability to commute to Monterey Park, CA office
• Two years of clinical experience as an LVN
• Experience in Skilled Nursing Facility (SNF) case management is a plus
• Proficiency in Microsoft Word, Excel, and Outlook
• Excellent analytical and critical reasoning skills
• Ability to prioritize multiple responsibilities in a fast-paced environment
• Strong communication and customer service skills
• Detail-oriented with good organization and problem-solving skills

Nice-to-haves

• Experience using EZCAP
• Ability to educate and train staff members
• Creative and self-motivated
• Professional appearance and conduct
• Conceptual and big picture understanding
• Willingness to learn and develop new responsibilities

Benefits

• Competitive hourly wage of $30 - $45
• Hybrid work environment
• Opportunity to work with a leading healthcare provider