Inpatient Case Manager, LVN/RN

Astrana Health

. Comply with Case Management Department policies and procedures .

Posted 9/23/2026full-timeJohnston • Rhode Island • United StatesJuniorMid-Level💰 $36 - $41 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management processes, including compliance with Utilization Management standards and effective discharge planning. Proficient in utilizing Milliman Care Guidelines and maintaining relationships with healthcare providers to enhance patient care and reduce readmissions.

Highest-signal resume keywords

Active Rhode Island RN LicenseClinical Nursing ExperienceUtilization Management ExperienceCase Management ExperienceMicrosoft Office Suite Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Record ReviewAssessment and PlanningCare CoordinationDischarge PlanningAnalytical SkillsCritical ReasoningDaily Inpatient Admission ReportingTransition of CareMonitoring and EvaluationIssue Resolution

Soft Skills

Strong Communication SkillsRelationship-BuildingCustomer Service SkillsAbility to Educate and TrainAbility to Prioritize Responsibilities

Tools & Technologies

EZCAPMicrosoft WordMicrosoft ExcelMicrosoft Outlook

Certifications & Qualifications

Active Rhode Island LVN License

Industry Keywords

Case ManagementUtilization ManagementHealth Plan Delegation StandardsTransition of CareSkilled Nursing NeedsAcute Rehabilitation PlacementRegulatory RequirementsAccreditation Requirements

About the role

Key responsibilities & impact

Comply with Case Management Department policies and procedures
Achieve 95-100% compliance with Utilization Management health plan delegation standards for Case Management
Utilize Milliman Care Guidelines criteria for transition of care, skilled nursing needs, and acute rehabilitation placement recommendations
Collaborate with hospitalists, case managers, and discharge planners to establish discharge plans upon admission
Coordinate initial and concurrent reviews through medical record review and provide accurate daily inpatient admission reporting to leadership
Review medical records and supporting documentation to determine medical necessity, appropriateness, and level of care
Assess, plan, implement, coordinate, monitor, and evaluate services with the goal of reducing hospital readmissions
Attend and coordinate case management meetings on-site and off-site as required
Communicate determination outcomes to providers and members in accordance with regulatory and accreditation requirements
Respond to provider and interdepartmental inquiries while demonstrating exceptional customer service
Maintain productive relationships with health plans, hospitals, and medical directors and assist with issue resolution
Report daily activities, trends, and concerns to Case Management leadership

Requirements

What you’ll need

Active Rhode Island RN license or active Rhode Island LVN license
At least 2 years of clinical nursing experience
Ability to commute to the Johnston, Rhode Island office
Proficiency with Microsoft Office Suite, including Word, Excel, and Outlook
Strong analytical and critical reasoning skills
Ability to prioritize multiple responsibilities in a fast-paced environment while meeting deadlines
Ability to educate and train staff and cross-functional departments
Strong communication, relationship-building, and customer service skills
Previous case management experience preferred
Experience using EZCAP preferred
Experience working with utilization management or care coordination programs preferred
Familiarity with transition of care and discharge planning processes preferred

Benefits

Comp & perks

Full-time position located in Johnston, Rhode Island
Standard day schedule, Monday through Friday
Frequent use of a computer, telephone, and standard office equipment
Ability to work in a fast-paced environment while managing multiple priorities and deadlines
Occasional travel to on-site and off-site meetings as needed