Case Manager (LVN or RN) - Hybrid / Field in Houston, TX
Department : Operations
Employment Type : Full Time
Location : 19500 HWY 249, Suite 570 Houston, TX 77070
Reporting To : Marlene Martinez
Compensation : $34.00 - $50.00 / hour
Description
Astrana Health is looking for a LVN or RN Case Manager in the greater Houston, TX area. We're open to training candidates without prior case management experience. This role offers the opportunity to work with pediatric and / or adult populations, depending on business needs.
Our Values :
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
Comply with Case Management Department's policies and procedures95 - 100% compliance with Utilization Management health plan delegation standards for Case ManagementUtilize Milliman Care Guidelines criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge planCollaborating with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admissionResponsible 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 DepartmentReview of medical records and / or other documentation to determine medical necessity, appropriateness and level of care utilizing Milliman Care and other appropriate GuidelinesAssess, plan, implement, coordinate, monitor, and evaluate all options and services with the goal of reducing hospital readmissionAttends / coordinates Case Management meetings on and off-site as necessaryInteracts with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirementsAttend to provider and interdepartmental calls in accordance with exceptional customer serviceMaintain good relationships with health plans, hospitals and medical directors. Resolve problems that arise with any IPA medical directorsReport to Manager and / or Supervisor of Case Management on activities and / or problems occurring throughout the dayAvailable for Hospital on site Case ManagementOther duties as assignedQualifications
Active Registered Nurse (RN) license in Texas OR active Licensed Vocational Nurse (LVN) license in TexasExperience using Microsoft applications such as Word, Excel and OutlookAt least two (2) years of clinical experience as an RN / LVNYou're great for this role if :
Excellent analytical critical reasoningProven ability to prioritize multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlinesAbility to educate and train staff members and other departments as neededExperience using EZCAPStrong communication and customer service skillsEnvironmental Job Requirements and Working Conditions
This position is based in Houston, TX. This role follows a primarily remote work structure; however, the candidate must be available to attend on-site meetings as needed at 19500 HWY 249, Suite 570 Houston, TX 77070.This role is required to visit patients in our partnered hospitals surrounding Houston, TX.The target pay range for this role is between $34.00 - $50.00 per hour. The salary range represents our national target range for this role.Astrana Health is proud to be an 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 conditions), 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 humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information :
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change
