Inpatient Case Manager (RN/LVN) — Care Transitions Expert

RiseMe; Rhode Island; On-site; USD 50,000 - 56,000; Full time

Job summary

Astrana Health is seeking a dedicated Inpatient Case Manager (RN/LVN) to support our Care Management team in Johnston, RI. You will coordinate care for adult patients, facilitate safe transitions, and assist with utilization management to reduce readmissions.

The ideal candidate has strong clinical experience and critical thinking skills, with training available for those new to case management. This full-time role requires commuting to the Johnston office.

Qualifications

• Active Rhode Island RN license or active Rhode Island LVN 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.

Responsibilities

• Comply with Case Management Department policies and procedures.
• Achieve 95-100% compliance with Utilization Management health plan delegation standards for Case Management.
• Utilize Milliman Care Guidelines 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.

Skills

Critical thinking

Communication

Microsoft Office

Education

Rhode Island RN license

Rhode Island LVN license

Tools

Microsoft Office Suite

Job description

Astrana Health is seeking a dedicated Inpatient Case Manager (RN/LVN) to support our Care Management team in Johnston, RI. You will coordinate care for adult patients, facilitate safe transitions, and assist with utilization management to reduce readmissions.

The ideal candidate has strong clinical experience and critical thinking skills, with training available for those new to case management. This full-time role requires commuting to the Johnston office.