Inpatient Case Manager (LVN or RN) Astrana Health, Inc. - 1.7 Johnston, RI Job Details Full-time $36 - $41 an hour 20 hours ago Qualifications Customer communication Microsoft Excel Customer relationship building Microsoft Outlook Customer inquiry handling Clinical staff training Staff training Cross-functional communication Full Job Description 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 About Astrana Health, Inc. 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 20,000 physicians to provide care for over 1.7 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.