Case Manager - Pediatric Sub-Acute

Job Description

Job Description

Description

We are currently seeking a highly motivated Pediatric Case Manager. This role will report to the Supervisor – Inpatient Case Management and enable us to continue to scale in the healthcare industry. This is an on-site role where the expectation is to work at Foothill Regional Medical Center. 

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’s policies and procedures
• 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management
• Utilize Milliman Care Guidelines, CMS, Title 22 guidelines and criteria for appropriateness of transition of care for members in SNF, SA, ARU, LTAC setting
• 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 accurate reporting of all 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, facilities 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

Qualifications

• Bachelors’ degree in Nursing, or LVN 
• Active Licensed Vocational Nurse (LVN) or Registered Nurse (RN) license in California
• Experience using Microsoft applications such as Word, Excel and Outlook
• At least Two (2) years of clinical knowledge and experience as an LVN
• Skilled Nursing Facility experience a plus

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
• Punctual, Creative, self-motivated
• Professional appearance and conduct
• Conceptual and “big picture” understanding
• Able to function independently under time constraints
• Willing to learn and develop new responsibilities and skills
• Good organization, critical thinking and problem-solving skills
• Must be detail-oriented and able to work autonomously but also as a team member
• Have experience in SNF case management

Environmental Job Requirements and Working Conditions

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, 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 View email address on ziprecruiter.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.