Case Manager (Home Health/Hospice) *Hybrid*
Description
Job Title: Case Manager (Home Health/Hospice) *Hybrid*
Department: Health Services - ICM
Department: Health Services - ICM
About the Role:
We are currently seeking a highly motivated Case Manager. This role will report to the Sr. Manager – Inpatient Case Management and enable us to continue to scale in the healthcare industry. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis.
What You'll Do:
- Comply with Case Management policies and procedures
- Provide support to Medical Directors on day-to-day activities
- Notify MD of urgent authorization requests for medical review
- Process Routine, Urgent and retro treatment authorization requests
- Provide authorization(s) for services requested on discharge (i.e., Home Health, hospice, DME, others)
- 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 - Provide outreach for clarification of authorization requests (access to care, site of care, additional documents - face
sheet, medical records, hospital order etc., and other outreach as needed - Accurately review, screen and process daily assigned cases to determine medical necessity, appropriateness and
level of care utilizing Milliman Care and other appropriate criteria rules in accordance with IPA and health plan
turnaround time guidelines. - Responsible for verification and documentation to include but not limited to: DOFR, eligibility, benefit, provider
status (contracted/non-contracted), delegation agreements and others - Verify facility/provider contract and whether a CMS approved facility when required
- Attach all incoming medical records to appropriate authorizations
- Assess, plan, implement, coordinate, monitor, and evaluate all options and services with the goal of reducing
hospital readmission - Ensures the privacy and security PHI (Protected Health Information) as outlined in Astrana’s policies and procedures
relating to HIPPA compliance - Perform/participate in audit requirements and other duties or additional tasks and projects as assigned by
Supervisor, Manager and/or Medical Director - Report to Manager or Supervisor on activities 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
- Ability to commute to our Monterey Park, CA office
- Experience using Microsoft applications such as Word, Excel and Outlook
- Two (2) years of clinical experience as an LVN
You're great for this role if:
- Experience using EZCAP
- Have experience in home health or hospice case management
Who We Are:
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 in order to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.
Our platform currently empowers over 10,000 physicians to provide care for over 1 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 in order to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity and Excellence
- Be Innovative
- Work as One Team
Environmental Job Requirements and Working Conditions:
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
- The total compensation target pay range for this role is: $30.00 to $38.00 per hour. The salary range represents our national target range for this role.
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 [email protected] 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.
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