Description
The RN Case Manager conducts clinical assessments of acute care inpatients to support utilization review, resource management, and safe discharge planning. Partners with the interdisciplinary team to coordinate timely, cost‑effective care and smooth transitions across the continuum. Advocates for patient choice while respecting patient and family diversity. Monitors resource utilization and timeliness of services, and completes admission, continued stay, and discharge reviews using approved criteria.
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
- Collaborates with patients, families, providers, payers, and community resources to coordinate transfers, discharges, transitions of care, and post‑hospital services.
- Identifies appropriate levels of care based on medical necessity, patient preferences, stability, and health plan benefits; provides referrals and resources as needed.
- Reviews medical necessity and length of stay using approved criteria; completes utilization review, documents delays/avoidable days, and escalates unresolved issues promptly.
- Partners with patients, caregivers, physicians, and the multidisciplinary team to set goals and complete timely discharge planning assessments and documentation.
- Serves as a liaison to medical staff, participates in patient/family meetings, supports informed decision‑making, and contributes data to the Utilization Management Committee.
Qualifications
Required Qualifications:
- One year of case management experience or 1 year nursing leadership experience· Current Licensure as a Registered Nurse in the State of California
- In-depth knowledge and strong understanding of patient throughput, care coordination, and care planning processes
- Ability to assess medical stability for discharge and evaluate medical necessity for continued acute hospitalization
- Computer/EMR Proficiency and Literacy
- Knowledge of CMS, Medicare, Medi-Cal and Managed Care reimbursement
- Familiarity of Joint Commission, CMS, CDPH requirements
- Excellent written and verbal communication skills in English
- Ability to establish and maintain effective working relationships across the organization
- Ability to facilitate and lead interdisciplinary rounds
Preferred Qualifications:
- Bachelor of Science in Nursing
- Certified Case Manager (CCM)
- Acute Hospital Case Management Experience
- Familiarity with AllScripts Care Management
- Proficiency with Milliman Care Guidelines or Interqual
- Bilingual skills to communicate effectively with patients and families
Environmental Job Requirements and Working Conditions
- The base pay range for this role is $48 - $72 per hour. This salary range represents our national target range for this role.
- This role follows an onsite work structure where the expectation is to work 5 days in office. The office is located at 14662 Newport Ave, Tustin, CA.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on 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 based on 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.
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.