Case Manager (Part-time - Night Shift)

Case Manager (Part-time - Night Shift) Department: HS - ICM Employment Type: Part Time Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Reporting To: Juan Gil Compensation: $32.00 - $40.00 / hour Description Job Title: Case Manager - LVN/RN Department: Health Services - ICM This is a part-time role. About the Role: Astrana Health is looking for a LVN or RN Case Manager and we are willing to train without case management experience! You'll perform initial assessment of patient’s condition requiring admission to an acute level of care per Milliman Care Guidelines. Based on the information presented-at times limited, efficiently determining the best action for the patient’s care and needs. Successfully transferring members into the appropriate facilities, level of care and managing ER diversions when appropriate."

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 criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge plan
• 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 daily accurate reporting of all 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 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, 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

Qualifications

• Active Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license in California
• Experience using Microsoft applications such as Word, Excel and Outlook
• Hospice and Home Health Nursing experience is 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

Environmental Job Requirements and Working Conditions

• This is a remote role. The home office is aligned with your department at 600 City Parkway West, 10th Floor, Orange, CA 92868.
• The total compensation target pay range for this role is $32.00 - $40.00 per hour. The salary range represents our national target range for this role.
• This role would target 24 - 29 hours per week (6 - 8-hour shifts). Working shifts fall between 5:00 PM - 11:30 PM, or 11:00 PM - 8:00 AM
• Nurses are expected to do rotating weekends and required to meet 4 weekend days per month. Able to do every Saturday or every Sunday if they prefer.

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