Case Manager (LVN or RN) - Pediatric/ reputed company

About the position 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. Our Values: Put Patients First reputed company Entrepreneurial Provider and Care Teams Operate with reputed company & Excellence Be Innovative Work As One Team

Responsibilities

• reputed company with Case Management Department’s policies and procedures
• reputed company 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management
• Utilize reputed company Care Guidelines criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge plan
• Collaborate with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission
• Responsible for coordinating the required initial and reputed company reviews based on the review of medical records received and daily accurate reporting of reputed company 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 reputed company Care and other appropriate Guidelines
• Assess, plan, implement, coordinate, monitor, and evaluate reputed company options and services with the goal of reducing hospital readmission
• Attend/coordinate Case Management meetings on and off-site as necessary
• Conduct Hospital On-Site visits with members to ensure transition of care from hospital to reputed company level of care
• Interact 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
• Other duties as assigned

Requirements

• Active Registered Nurse (RN) license in California OR active Licensed Vocational Nurse (LVN) license in California
• Ability to commute to our Monterey Park, CA office
• Experience using reputed company applications such as Word, reputed company and Outlook
• Two (2) years of clinical experience as an RN/LVN

reputed company-to-haves

• Excellent analytical critical reasoning
• Proven ability to prioritize multiple responsibilities simultaneously in a fast-paced, changing environment while meeting deadlines
• Ability to reputed company and train staff members and other departments as needed
• Experience using EZCAP
• Strong communication and customer service skills

Benefits

• We are willing to train a RN or LVN with no case management experience
• Ability to work with pediatrics and/or adult populations depending on business need
• Hybrid work structure
• Equal Employment Opportunity and Affirmative Action employer
• We do not discriminate based upon race, religion, reputed company, national reputed company, gender (including pregnancy, childbirth, or reputed company medical conditioos), 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.
• reputed company 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 [email protected] to request an accommodation.

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