Case Manager (LVN or RN) *Hybrid* - Temporary

$62,400 - $93,600/Yr

Astrana Health - Monterey Park, CA

Full-time - Mid Level

Hybrid - Monterey Park, CA

11-50 employees

About the position

The Case Manager (LVN or RN) position at Astrana Health is a temporary hybrid role focused on managing patient care transitions in skilled nursing facilities. The role involves collaborating with healthcare providers to establish discharge plans, ensuring compliance with health plan standards, and utilizing clinical guidelines to assess and coordinate care. This position is essential for reducing hospital readmissions and improving patient outcomes within a technology-driven healthcare management framework.

Responsibilities

• Comply with Case Management Department's policies and procedures
• Ensure 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
• Collaborate with Hospitalists, case managers, and discharge planners to establish discharge plans
• Coordinate initial and concurrent reviews based on medical records
• 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 as necessary
• Communicate determination outcomes to providers or members
• Maintain relationships with health plans, facilities, and medical directors
• Report activities and problems to Manager and/or Supervisor of Case Management

Requirements

• Bachelor's degree in Nursing or LVN
• Active LVN or RN license in California
• Ability to commute to Monterey Park, CA office
• Experience using Microsoft Word, Excel, and Outlook
• Two years of clinical experience as an LVN or RN
• Skilled Nursing Facility experience is a plus

Nice-to-haves

• Experience using EZCAP
• Excellent analytical and critical reasoning skills
• Ability to prioritize multiple responsibilities in a fast-paced environment
• Experience in educating and training staff members
• Strong communication and customer service skills
• Detail-oriented with good organization and problem-solving skills

Benefits

• Competitive hourly pay range of $30.00 to $45.00
• Temporary position with potential for extension
• Hybrid work structure allowing both in-office and remote work