- Comply with Case Management Department's policies and procedures
- % 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
- Active Registered Nurse (RN) license in Nevada
- Experience using Microsoft applications such as Word, Excel and Outlook
- At least two (2) years of clinical experience as an RN
- 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
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
- This position is in office. The office is located at 8880 W Sunset Road, Floor 3, Las Vegas, NV
- The target pay range for this role is between $ $45.00 per hour. The salary range represents our national target range for this role.
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Case Manager - Las Vegas, United States - Astrana Health
Description
Job Title: Case Manager, RN
Department: Health Services - ICM
About the Role:
Astrana Health is looking for a RN Case Manager and we are willing to train a RN without case management experience
What You'll Do:
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.
Our platform currently empowers over 10,000 physicians to provide care for over 1.2 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Our Values:
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
