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Astrana Health is looking for a LVN or RN Case Manager in the greater Houston, TX area. We’re open to training candidates without prior case management experience. This role offers the opportunity to work with pediatric and/or adult populations, depending on business needs.
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’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
Collaborate 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
Available for Hospital on site Case Management
Other duties as assigned
Qualifications
Active Registered Nurse (RN) license in Texas OR active Licensed Vocational Nurse (LVN) license in Texas
Experience using Microsoft applications such as Word, Excel and Outlook
At least two (2) years of clinical experience as an RN/LVN
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 position is based in Houston, TX. This role follows a primarily remote work structure; however, the candidate must be available to attend on‑site meetings as needed at 19500 HWY 249, Suite 570 Houston, TX 77070.
This role is required to visit patients in our partnered hospitals surrounding Houston, TX.
The target pay range for this role is between $34.00 – $50.00 per hour. The salary range represents our target range for this role.
Astrana Health is proud to be an Equal Employment Opportunity and Aff. Action employer. We do not discriminate based upon disability, age, gender, race, color, religion, national origin, sexual orientation, gender identity, marital status, veteran status, medical condition, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
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.
If you are interested in applying for this job please press the Apply Button and follow the application process. Energy Jobline wishes you the very best of luck in your next career move.