Inpatient Nurse Case Manager

$104,000 - $149,760/Yr

Altais - Los Angeles, CA

Full-time - Mid Level

Remote - Los Angeles, CA

1,001-5,000 employees

About the position

The Inpatient Nurse Case Manager at Altais is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating healthcare services for members across the care continuum. This role involves on-site visits to local hospitals in the Los Angeles area, ensuring that members receive appropriate levels of care from admission through discharge, and facilitating timely discharge planning. The position requires strong clinical knowledge and communication skills to support decision-making and manage care effectively.

Responsibilities

• Conduct onsite or electronic concurrent reviews to assess and coordinate member health needs.
• Ensure members are at the appropriate level of care from admission through discharge.
• Provide timely discharge planning and facilitate high-quality, cost-effective outcomes.
• Evaluate requests for authorization, verifying eligibility and medical necessity.
• Communicate regularly with internal and external partners regarding clinical decisions.
• Assess and triage patients, providing concise SBAR to medical directors.
• Conduct clinical reviews as required by health plan delegation agreements.
• Issue facility denial letters as appropriate to the hospital.
• Assist in developing and implementing care standards and protocols.
• Participate in training or orientation of new team members.

Requirements

• Bachelor of Nursing degree preferred.
• Current California unrestricted RN or LVN license required.
• Minimum of three years recent acute clinical experience in a hospital setting.
• Managed care experience desirable.
• Discharge planning experience preferred in an acute care or skilled nursing facility.
• Basic computer skills including electronic medical records, Outlook email, and Microsoft Office suite.
• Ability to read and understand inpatient medical records and extract pertinent data.
• Effective verbal and written communication skills.
• Working knowledge of utilization management and medical necessity criteria.
• Knowledge of managed care concepts and Medicare/Medi-Cal guidelines.

Nice-to-haves

• Experience in a skilled nursing facility.
• Familiarity with InterQual criteria.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Paid time off
• Parental leave
• Employee assistance program
• 401(k) matching
• Referral program