About Our Company
At Altais, we're looking for bold and curious clinicians and innovators who share our passion for enabling better health care experiences and revolutionizing the healthcare system for physicians, advanced care providers, patients, and the clinical community. At Altais, we're building breakthrough clinical support tools, technology, and services to let doctors do what they do best: care for people. We invite you to join our growing passionate team as we change the game for the future of healthcare and enable the experience that people need and deserve. Altais family of companies include Brown & Toland Physicians, Family Care Specialists and Altais Medical Groups.
About Your Team
Are you looking to work with a high performing, fast growing and dynamic Inpatient Care Management team? We are 4,000+ physicians, working in over 40 cities throughout California, caring for more than 500,000 patients. If you are passionate about reshaping healthcare and want to work for a mission driven organization where new ideas and innovation are valued, then we would like to meet you.
About Your Work
This role requires on-site visits to local hospitals in San Francisco.
Your focus will be on:

• Through onsite or electronic concurrent review will assess, plan, implement, coordinate, monitor and evaluate the options and services needed to meet the member's health needs across the care continuum and provide quality, cost-effective outcomes
• Assure that members are at the appropriate level of care from admission through discharge and provide timely discharge planning.
• Utilize clinical knowledge, problem solving and decision-making skills to evaluate requests for authorization which includes screening for appropriateness, verifying eligibility, interpretation of benefits and medical necessity
• Researching issues to facilitate objective medical management decisions based upon approved criteria, standards and guidelines
• Regular communication with internal and external partners for clinical decisions regarding medical necessity and timely access to care
• Assess and triage patients, providing concise SBAR to medical directors to support decision-making
• Conduct clinical review as required by Health plan delegation agreement to resolve challenges and service denials
• Issues facility denial letters as appropriate to the hospital
• Provide case management activities across the continuum of care in order to facilitate and promote high quality, cost effective outcomes
• Assist in the development, implementation and evaluation of care standards, policies,
• procedures and protocols to improve Care Management across the care continuum
• Participate in training or orientation of new team members

The Skills, Experience & Education You Bring

• Bachelor of Nursing degree preferred
• Current California unrestricted RN license required
• Minimum of three (3) years recent acute clinical experience required in a hospital setting.
• Managed care experience desirable
• Discharge planning experience preferred in an acute care or skilled nursing facility
• Basic computer skills including electronic medical records, Outlook email, and Microsoft Office suite
• Ability to read and understand inpatient medical records and extract data pertinent to the projected trajectory of a member's hospital course and compare it to nationally recognized treatment standards.
• Effective verbal and written communication skills, to represent the organization and be a patient advocate; Internal and external customer focused.
• Working knowledge of utilization management, reimbursement, medical necessity criteria including InterQual. Knowledge of managed care concepts, Medicare/Medi-Cal Guidelines.
• A strong understanding of health plan benefits and the ability to formulate an effective discharge plan and communicate it to the various stakeholders.

You Share our Mission & Values

• You are passionate about improving the healthcare experience and want to be part of the Altais mission.
• You are bold and curious - willing to take risks, try new things and be creative.
• You take pride in your work and are accountable for the quality of everything you do, holding yourself and others to a high standard.
• You are compassionate and are known as someone who demonstrates emotional intelligence, considers others when making decisions and always tries to do the right thing.
• You co-create , knowing that we can be better as a team than individuals. You work well with others, collaborating and valuing diversity of thought and perspective.
• You build trust with your colleagues and customers by demonstrating that you are someone who values honesty and transparency.

Altais values the contribution each Team Member brings to our organization. Final determination of a successful candidate's starting pay will vary based on several factors, including, but not limited to education and experience within the job or the industry. The pay scale listed for this position is generally for candidates that meet the specified qualifications and requirements listed on this job description. Additional pay may be determined for those candidates that exceed these specified qualifications and requirements. We provide a competitive compensation package that recognizes your experience, credentials, and education alongside a robust benefits program to meet your needs.
The anticipated pay range for this role is listed in our salary posting for transparency but may vary based on factors including the candidate's qualifications, skills, licensure, and experience.
Altais and its subsidiaries and affiliates are committed to protecting the privacy and security of the personal information you provide to us. Please refer to our 'CPRA Privacy Notice for California Employees and Applicants' to learn how we collect and process your personal information when you apply for a role with us.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of workday.
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.