Case Manager - LVN/RN *Hybrid*

$62,400 - $72,800/Yr

Astrana Health - Monterey Park, CA

Full-time - Mid Level

Hybrid - Monterey Park, CA

About the position

We are currently seeking a highly motivated Case Manager to join our Health Services - ICM department at Astrana Health. This role is essential for our continued growth in the healthcare industry and will report directly to the Supervisor of Inpatient Case Management. The position is hybrid, requiring the employee to work both in the office and remotely on a weekly basis. As a Case Manager, you will be responsible for ensuring compliance with the Case Management Department's policies and procedures, achieving 95 - 100% compliance with Utilization Management health plan delegation standards. You will utilize Milliman Care Guidelines, CMS, and Title 22 guidelines to assess the appropriateness of care transitions for members in various settings including Skilled Nursing Facilities (SNF), Subacute (SA), Acute Rehabilitation Units (ARU), and Long-Term Acute Care (LTAC). Your role will involve collaborating with Hospitalists, case managers, and discharge planners to establish effective discharge plans at the time of admission. You will coordinate initial and concurrent reviews based on medical records, ensuring accurate reporting of all admissions to the Medical Director and Case Management Supervisor. Additionally, you will review medical records to determine medical necessity and appropriateness of care, while assessing, planning, implementing, coordinating, monitoring, and evaluating all options and services aimed at reducing hospital readmissions. You will also attend and coordinate Case Management meetings, interact with providers and members to communicate determination outcomes, and maintain strong relationships with health plans and medical directors. This position requires excellent analytical and critical reasoning skills, the ability to prioritize multiple responsibilities in a fast-paced environment, and a commitment to exceptional customer service. You will be expected to educate and train staff members and other departments as needed, and your experience in SNF case management will be highly valued. At Astrana Health, we are dedicated to empowering our physicians to provide high-quality, cost-effective care, and we are looking for a Case Manager who shares our mission and values.

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 appropriateness of transition of care
• Collaborate with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission
• Coordinate required initial and concurrent reviews based on medical records
• Accurately report all admissions to Medical Director and Manager/Supervisor of Case Management Department
• 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
• Maintain good relationships with health plans, facilities, and medical directors
• Resolve problems with IPA medical directors
• Report to Manager/Supervisor of Case Management on daily activities and problems

Requirements

• Bachelor's degree in Nursing or LVN
• Active Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license in California
• Ability to commute to Monterey Park, CA office
• Experience using Microsoft applications such as Word, Excel, and Outlook
• Two (2) years of clinical experience as an LVN
• Skilled Nursing Facility experience is a plus

Nice-to-haves

• Excellent analytical critical reasoning
• Proven ability to prioritize multiple responsibilities in a fast-paced environment
• Ability to educate and train staff members and other departments
• Experience using EZCAP
• Strong communication and customer service skills
• Punctual, creative, self-motivated
• Professional appearance and conduct
• Conceptual and big picture understanding
• Ability to function independently under time constraints
• Willingness to learn and develop new responsibilities and skills
• Good organization, critical thinking, and problem-solving skills
• Detail-oriented and able to work autonomously and as a team member
• Experience in SNF case management

Benefits

• Competitive hourly wage of $30 - $35
• Hybrid work structure allowing for both in-office and remote work
• Opportunity to work in a rapidly growing healthcare company
• Supportive work environment focused on patient care and employee development