Inpatient Nurse Care Manager - RN or LVN

About the position

The Inpatient Nurse Care Manager at Altais Health Solutions is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating healthcare services for members across the care continuum. This role focuses on ensuring that members receive appropriate levels of care from admission through discharge, utilizing clinical knowledge to facilitate effective medical management decisions. The position requires regular communication with internal and external partners to support timely access to care and involves case management activities to promote high-quality, cost-effective outcomes.

Responsibilities
• Conduct onsite or electronic concurrent reviews to assess and coordinate member health needs.
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• Ensure timely discharge planning and appropriate level of care from admission through discharge.
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• Evaluate requests for authorization, verifying eligibility and medical necessity.
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• Communicate regularly with internal and external partners regarding clinical decisions.
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• Assess and triage patients, providing concise SBAR to medical directors.
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• Conduct clinical reviews as required by Health plan delegation agreements.
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• Issue facility denial letters as appropriate to the hospital.
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• Facilitate case management activities across the continuum of care.
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• Assist in developing and evaluating care standards, policies, and procedures.
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• Participate in training or orientation of new team members.

Requirements
• Bachelor of Nursing degree preferred.
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• Current California unrestricted RN or LVN license required.
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• Minimum of three (3) years recent acute clinical experience in a hospital setting required.
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• Managed care experience desirable.
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• Discharge planning experience preferred in an acute care or skilled nursing facility.
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• Basic computer skills including electronic medical records, Outlook email, and Microsoft Office suite.
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• Ability to read and understand inpatient medical records and extract relevant data.
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• Effective verbal and written communication skills.
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• Working knowledge of utilization management and medical necessity criteria.
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• Knowledge of managed care concepts and Medicare/Medi-Cal guidelines.

Nice-to-haves
• Experience in a skilled nursing facility.
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• Familiarity with InterQual criteria.

Benefits
• Competitive compensation package
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• Work from home options
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• Robust benefits program

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