Case Manager (LVN or RN)

Job Description

Job Description

Description

Job Title : Case Manager I or II

Department : Health Services - ICM

About the Role :

Astrana is looking for a RN / LVN Case Manager and we are willing to train a RN or LVN with no case management experience! You will have the ability to work with pediatrics and / or adult populations depending on business need.

What You'll Do

• Comply with Case Management Department’s policies and procedures
• 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management
• Utilize Milliman Care Guidelines criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge plan
• Collaborating with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission
• Responsible 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 Department
• Review of medical records and / or other documentation to determine medical necessity, appropriateness and level of care utilizing Milliman Care and other appropriate Guidelines
• Assess, plan, implement, coordinate, monitor, and evaluate all options and services with the goal of reducing hospital readmission
• Attends / coordinates Case Management meetings on and off-site as necessary
• Interacts with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements
• Attend to provider and interdepartmental calls in accordance with exceptional customer service
• Maintain good relationships with health plans, hospitals and medical directors. Resolve problems that arise with any IPA medical directors
• Report to Manager and / or Supervisor of Case Management on activities and / or problems occurring throughout the day
• Available for Hospital on site Case Management
• Other duties as assigned

Qualifications

You're great for this role if :

Environmental Job Requirements and Working Conditions