Inpatient Case Manager - RN

Inpatient Case Manager - RNWe are currently seeking a highly motivated Inpatient Case Manager - RN 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.What You'll DoComply with Case Management Department policies and proceduresAchieve 95-100% compliance with Utilization Management health plan delegation standards for Case ManagementUtilize Interqual criteria for transition of care, skilled nursing needs, and acute rehabilitation placement recommendationsCollaborate with hospitalists, case managers, and discharge planners to establish discharge plans upon admissionCoordinate initial and concurrent reviews through medical record review and provide accurate daily inpatient admission reporting to leadershipReview medical records and supporting documentation to determine medical necessity, appropriateness, and level of careAssess, plan, implement, coordinate, monitor, and evaluate services with the goal of reducing hospital readmissionsAttend and coordinate case management meetings on-site and off-site as requiredCommunicate determination outcomes to providers and members in accordance with regulatory and accreditation requirementsRespond to provider and interdepartmental inquiries while demonstrating exceptional customer serviceMaintain productive relationships with health plans, hospitals, and medical directors and assist with issue resolutionReport daily activities, trends, and concerns to Case Management leadershipQualificationsActive Rhode Island RN licenseAt least 2 years of clinical nursing experienceAbility to commute to the Johnston, Rhode Island officeProficiency with Microsoft Office Suite, including Word, Excel, and OutlookStrong analytical and critical reasoning skillsAbility to prioritize multiple responsibilities in a fast-paced environment while meeting deadlinesAbility to educate and train staff and cross-functional departmentsStrong communication, relationship-building, and customer service skillsEnvironmental Job Requirements and Working ConditionsFull-time position located in Johnston, Rhode IslandStandard day schedule, Monday through FridayFrequent use of a computer, telephone, and standard office equipmentAbility to work in a fast-paced environment while managing multiple priorities and deadlinesOccasional travel to on-site and off-site meetings as neededAbout 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.