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Job description
Inpatient Case Manager (LVN or RN)
Department: HS - ICM
Employment Type: Full Time
Location: 1301 Atwood Avenue, Suite 206N, Johnston, RI 02919
Reporting To: Sonna Santa Ana
Compensation: $36.00 - $41.00 / hour
Description
About the Role
We are currently seeking a highly motivated Case Manager (RN/LVN) to support our Care Management team at Astrana Health. This role is responsible for coordinating care for adult patient populations, facilitating safe transitions of care, supporting utilization management activities, and reducing hospital readmissions.
The ideal candidate brings strong clinical experience, excellent critical thinking skills, and a passion for improving patient outcomes. We welcome nurses with diverse clinical backgrounds and are willing to train candidates who are new to case management.
Our Values
Put Patients First
Empower Entrepreneurial Provider and Care Teams
Operate with Integrity & Excellence
Be Innovative
Work As One Team
What You'll Do 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
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
Strong analytical and critical reasoning skills
Ability to prioritize multiple responsibilities in a fast-paced environment while meeting deadlines
Ability to educate and train staff and cross-functional departments
Strong communication, relationship-building, and customer service skills
Preferred Qualifications Previous case management experience
Experience using EZCAP
Experience working with utilization management or care coordination programs
Familiarity with transition of care and discharge planning processes
Licenses/Certifications Active Rhode Island RN license or active Rhode Island LVN license
Environmental Job Requirements and Working Conditions Full-time position located in Johnston, Rhode Island
Standard day schedule, Monday through Friday
Frequent use of a computer, telephone, and standard office equipment
Ability to work in a fast-paced environment while managing multiple priorities and deadlines
Occasional travel to on-site and off-site meetings as needed
Worksite address
johnston, RI, 02919, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.