Case Manager - Sub-Acute

Network Medical Management; Tustin (CA); On-site; USD 71,552 - 100,672; Full time

Job summary

Astrana Health is seeking a Pediatric Case Manager to join the Inpatient Case Management team. This on-site role supports Foothill Regional Medical Center and involves collaboration with hospitalists, discharge planners, and care teams.

Ideal candidates hold a CA LVN/RN license, have at least two years of LVN clinical experience, and are proficient with Microsoft Office. SNF experience is a plus and on-site work is required.

Qualifications

• Two years of clinical knowledge and experience as an LVN
• Bachelor's degree in Nursing or LVN
• Active LVN or RN license in California
• Experience using Microsoft Word, Excel and Outlook

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 in SNF/SA/ARU/LTAC
• Collaborate with hospitalists and discharge planners to establish discharge plans at admission
• Coordinate initial and concurrent reviews and report activities to Medical Director/Manager/Supervisor
• Review medical records to determine medical necessity and level of care
• Assess, plan, implement, coordinate, monitor and evaluate options to reduce hospital readmission
• Attend Case Management meetings on- and off-site as needed
• Communicate outcomes to providers in compliance with regulations
• Maintain relationships with health plans, facilities and medical directors
• Report daily activities and issues to Manager/Supervisor

Skills

Analytical thinking

Prioritization

Communication

Customer service

Autonomy

Education

Bachelor's degree in Nursing or LVN

Active LVN or RN license in California

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Job description

Compensation: $34.40 - $48.40 / hour

Department: 6570-Sub-Acute Pediatric

Location: 14662 Newport Ave, Tustin, CA 92780 ("HOSPITAL")

Compensation: $34.40 - $48.40 / hour

Description

We are currently seeking a highly motivated Pediatric Case Manager. This role will report to the Supervisor – Inpatient Case Management and enable us to continue to scale in the healthcare industry. This is an on-site role where the expectation is to work at Foothill Regional Medical Center.

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 procedures
• 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management
• Utilize Milliman Care Guidelines, CMS, Title 22 guidelines and criteria for appropriateness of transition of care for members in SNF, SA, ARU, LTAC setting
• 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 accurate reporting of all 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, facilities 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

Qualifications

• Bachelors’ degree in Nursing, or LVN
• Active Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license in California
• Experience using Microsoft applications such as Word, Excel and Outlook
• At least Two (2) years of clinical knowledge and experience as an LVN
• Skilled Nursing Facility experience a plus

You're great for this role if:

• Excellent analytical critical reasoning
• Proven ability to prioritize multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlines
• Ability to educate and train staff members and other departments as needed
• Experience using EZCAP
• Strong communication and customer service skills
• Punctual, Creative, self-motivated
• Professional appearance and conduct
• Conceptual and “big picture” understanding
• Able to function independently under time constraints
• Willing to learn and develop new responsibilities and skills
• Good organization, critical thinking and problem-solving skills
• Must be detail-oriented and able to work autonomously but also as a team member
• Have experience in SNF case management

Environmental Job Requirements and Working Conditions

Astrana Health is proud to be an Equal Employment Opportunity and Affidative 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 [e-mail] 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.