Inpatient Case Manager (RN/LVN): Elevate Care Transitions

Astrana Health, Inc.; Johnston (RI); On-site; USD 50,000 - 56,000; Full time

Job summary

Astrana Health, Inc. is seeking an Inpatient Case Manager (RN/LVN) to support our Care Management team in Johnston, RI. This role coordinates care for adult patients, facilitates safe transitions, supports utilization management, and helps reduce readmissions.

The ideal candidate has strong clinical experience and critical thinking, with a willingness to train those new to case management. This is a full-time position based in Johnston, RI.

Qualifications

• Active Rhode Island RN or LVN license.
• At least 2 years of clinical nursing experience.
• Ability to commute to the Johnston, RI office.
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook).
• Strong analytical and critical reasoning skills.
• Ability to manage multiple responsibilities in a fast-paced environment.

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 and placement recommendations.
• Collaborate with hospitalists, case managers, and discharge planners to establish discharge plans on admission.
• Coordinate initial and concurrent reviews through medical record review and provide accurate daily inpatient admission reporting.
• Review medical records to determine medical necessity, appropriateness, and level of care.
• Assess, plan, implement, coordinate, monitor, and evaluate services to reduce hospital readmissions.
• Attend and coordinate case management meetings on-site and off-site as required.
• Communicate determination outcomes to providers and members per regulatory requirements.
• Respond to inquiries with exceptional customer service.
• Maintain relationships with health plans and hospitals and assist with issue resolution.
• Report daily activities, trends, and concerns to Case Management leadership.

Skills

Clinical nursing

Critical thinking

Communication

MS Office

Education

Rhode Island RN or LVN license

Tools

Microsoft Word

Excel

Outlook

Job description

Astrana Health, Inc. is seeking an Inpatient Case Manager (RN/LVN) to support our Care Management team in Johnston, RI. This role coordinates care for adult patients, facilitates safe transitions, supports utilization management, and helps reduce readmissions.

The ideal candidate has strong clinical experience and critical thinking, with a willingness to train those new to case management. This is a full-time position based in Johnston, RI.