Inpatient Case Manager (LVN or RN)

Astrana Health Management; Johnston, Northern (RI, KY); Hybrid; USD 50,000 - 56,000; Full time

Job summary

Astrana Health is seeking an Inpatient Case Manager - RN to join our Care Management team in Johnston, RI. You will coordinate care for adults, facilitate safe transitions, and support utilization management to reduce readmissions.

The ideal candidate has strong clinical experience, sharp critical thinking, and a patient-centered approach. We welcome nurses from diverse backgrounds and will train those new to case management.

Qualifications

• Active Rhode Island RN license is required.
• Minimum 2 years of clinical nursing experience.
• Ability to commute to the Johnston, RI office.
• Proficiency with Microsoft Word, Excel and Outlook.
• Strong analytical and critical reasoning skills.
• Ability to prioritize multiple responsibilities in a fast-paced environment.
• Ability to educate and train staff across departments.
• Strong communication, relationship-building and customer service skills.

Responsibilities

• Comply with Case Management Department policies and procedures.
• Achieve 95-100% compliance with utilization management delegation standards.
• Use Interqual criteria for transition of care and placement recommendations.
• Collaborate with hospitalists, case managers and discharge planners on discharge plans.
• Provide daily inpatient admission reporting to leadership.
• Review records to determine medical necessity and level of care.
• Assess, plan, implement, coordinate, monitor and evaluate services to reduce readmissions.
• Attend and coordinate case management meetings on-site and off-site as required.
• Communicate outcomes to providers and members per regulatory requirements.
• Respond to inquiries with exceptional customer service.
• Maintain relationships with health plans, hospitals and medical directors; assist with issue resolution.
• Report daily activities and trends to Case Management leadership.

Skills

Communication skills

Critical thinking

Customer service

Relationship building

Education

Rhode Island RN license

2+ years clinical nursing experience

Tools

Microsoft Office

Job description

Inpatient Case Manager - RN

Department: HS - ICM

Employment Type: Full Time

Location: 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919

Reporting To: Sonna Santa Ana

Compensation: $36.00 - $41.00 / hour

Description

About the Role

We are currently seeking a highly motivated Inpatient Case Manager - RN to support our Care Management team at Astrana Health. This role is responsible for coordinating care for adult patient populations, facilitating safe transitions of care, supporting utilization management activities, and reducing hospital readmissions.

The ideal candidate brings strong clinical experience, excellent critical thinking skills, and a passion for improving patient outcomes. We welcome nurses with diverse clinical backgrounds and are willing to train candidates who are new to case management.

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 policies and procedures


• Achieve 95-100% compliance with Utilization Management health plan delegation standards for Case Management


• Utilize Interqual criteria for transition of care, skilled nursing needs, and acute rehabilitation placement recommendations


• Collaborate with hospitalists, case managers, and discharge planners to establish discharge plans upon admission


• Coordinate initial and concurrent reviews through medical record review and provide accurate daily inpatient admission reporting to leadership


• Review medical records and supporting documentation to determine medical necessity, appropriateness, and level of care


• Assess, plan, implement, coordinate, monitor, and evaluate services with the goal of reducing hospital readmissions


• Attend and coordinate case management meetings on-site and off-site as required


• Communicate determination outcomes to providers and members in accordance with regulatory and accreditation requirements


• Respond to provider and interdepartmental inquiries while demonstrating exceptional customer service


• Maintain productive relationships with health plans, hospitals, and medical directors and assist with issue resolution


• Report daily activities, trends, and concerns to Case Management leadership

Qualifications

• Active Rhode Island RN license


• At least 2 years of clinical nursing experience


• Ability to commute to the Johnston, Rhode Island office


• Proficiency with Microsoft Office Suite, including Word, Excel, and Outlook


• Strong analytical and critical reasoning skills


• Ability to prioritize multiple responsibilities in a fast-paced environment while meeting deadlines


• Ability to educate and train staff and cross-functional departments


• Strong communication, relationship-building, and customer service skills

Preferred Qualifications

• Previous case management experience


• Experience using EZCAP


• Experience working with utilization management or care coordination programs


• Familiarity with transition of care and discharge planning processes

Licenses/Certifications

• Active Rhode Island RN license

Environmental Job Requirements and Working Conditions

• Full-time position located in Johnston, Rhode Island


• Standard day schedule, Monday through Friday


• Frequent use of a computer, telephone, and standard office equipment


• Ability to work in a fast-paced environment while managing multiple priorities and deadlines


• Occasional travel to on-site and off-site meetings as needed