Jobs and Careers

Case Manager (Home Health/Hospice) Hybrid

Monterey Park, United Statesfull_timeVerifiedPosted 4 Nov 2024

💰 $76,000/yr($60,000/yr – $76,000/yr)

About the role

Job Title: Case Manager (Home Health/Hospice) *Hybrid*
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: