Case Manager

5 days ago

Monterey Park, United States Astrana Health Full time

Job Title: Case Manager (LVN) - HYBRID

Department: Health Services - ECM

**About the Role**:
Provide efficient and effective Care Management to qualified members by addressing the member’s medical, physical and psychosocial needs. Using clinical judgement develops, modifies and assists the member to implement their care plan. Ensure all tasks are timely and in compliance with time requirements per Model of Care/Health Plan/DHCS. This position will entail a caseload of 50 members.

**What You'll Do**:

- Comply with organization and department policies & procedures and Model of Care to ensure all appropriate services for the eligible population are completed and acted upon within established timeframes
- Collaborate with a team of Community healthcare workers to address social needs
- Manage a case load of 50 Medi-Cal members with complex needs
- Adhere to DHCS requirements to include outreach within required time frame, comprehensive assessment/HRA-Health Risk Assessment, care plan creation to address all medical and social needs, ICT performance, coordination of care for all transitions of care to include PCP post hospital/SNF follow up appointments, risk stratification of members based on assessment and outreach performance based on risk stratification
- Review claims and authorization data for member history and care planning
- Perform medication reconciliations per initial assessments and transitions of care
- Offer services where the member lives, seeks care, or finds most easily accessible and within health plan guidelines
- Connect member to other social services and support, including transportation services, and provide referrals as appropriate
- Use motivational interviewing, trauma
- informed care, and harm-reduction approaches
- Coordinate with hospital staff on discharge plan and coordination of care
- Evaluate assessment findings against evidenced-based guidelines to develop a plan of care based on member needs and findings with collaboration from interdisciplinary team
- Identify potential barriers to adherence to treatment plan and modifies plan by mutual agreement with the member
- Educate member/caregiver on specific disease using approved evidence-based guideline and modify plan of care/goals based on member’s readiness to change
- Facilitates care coordination across the care continuum (home, hospital, home health)
- Attends/participates in interdisciplinary team meetings
- Provides enrollee with support telephonically to ensure appropriate utilization of benefits, treatment and plan of care, and member’s understanding of healthcare system
- Participates in all health plan audits and seminars as applicable

**Qualifications**:

- Current and active LVN CA license
- Experience with clinical issues and guidelines
- Excellent analytical, critical reasoning, organizational and interpersonal communication skills
- Strong written and oral communication skills
- Ability to multi-task, work autonomously, and think outside the box
- Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information is required.
- Proficient with Microsoft Office (Word, Excel, Power Point), EZCAP

**You're a great fit for this role if**:

- Knowledge of enhanced case management, SNP case management, complex case management
- Experience in managed care environment - health plans, IPA, or MSO
- 1+ years of Case Manager experience
- Basic knowledge of DHCS, DMHC, NCQA, ICE, and CMS standards
- Bachelor's degree

**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 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 to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

**Our Values**:

- _ Put Patients First_
- _ Empower Entrepreneurial Provider and Care Teams_
- _ Operate with Integrity & Excellence_
- _ Be Innovative_
- _ Work As One Team_

**Environmental Job Requirements and Working Conditions**:

- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Cent

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