Inpatient Case Manager (LVN or RN)

Job description

Inpatient Case Manager (LVN or RN)

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.