ACM Case Manager LVN
5 days ago
Astrana Health is seeking a highly skilled and compassionate ACM Case Manager LVN to join our team. As a Disease Management Case Manager, you will play a critical role in providing exceptional care to our patients with chronic health conditions.
Key Responsibilities- Comply with company and department policies & procedures to ensure all appropriate assessments for the eligible population are completed and acted upon within established timeframes.
- Responsible for reviewing Health Plan reports/requests/HRA for new patients assigned to Coordination of Care, Basic Case Management, Complex Case Management, and SNP
- Responsible for the care management (coordination of outpatient care) of patients with catastrophic illnesses and chronically ill while ensuring the quality-of-care standards are met by using clinical judgment to assess and/or evaluate.
- Caseload: Minimum contact 10 cases per day
- Identify and evaluate patients for enrollment into one of the case management programs: complex case management, SNP, Transplant, BCM, patient education, ESRD...etc. and update progress to various health providers (including but not limited to health plan, physician, and patient) to ensure compliance.
- Conducts telephonic assessments to identify patients' medical, physical, and psychosocial needs.
- Assess identified patients in a timely fashion to ensure appropriate individualized care plans are developed with the member to eliminate or reduce unnecessary admissions/re-admissions.
- Based upon care management criteria, contact and complete assessments for patients identified as potential candidates for disease management.
- Evaluates assessment findings against evidenced-based guidelines to develop a plan of care based on patient needs and findings with collaboration from the interdisciplinary team.
- Identifies potential barriers to adherence to treatment plan and modifies plan by mutual agreement with the patient.
- Educates patient/caregiver on specific disease using approved evidence-based guideline and using clinical judgment, modifies plan of care/goals based on patient's readiness to change.
- Facilitates care coordination across the care continuum (home, hospital, home health, outpatient, etc.), identifies community resources, and makes referrals as appropriate.
- Encourage patients to take an active role in both chronic disease and health prevention utilizing self-management support and patient education.
- Discuss self-management goals with the patient and assists them in selecting appropriate goals.
- Assesses cultural and linguistic needs and preference.
- Consistently documents activities and interventions provided to the patient.
- Attends/participates in staff meetings and interdisciplinary team meetings.
- Prepares and presents cases in Interdisciplinary Care Team meetings.
- Evaluates assessment finding, develops case presentation for the Interdisciplinary Care Team (ICT), and incorporates ICT recommendations into the patient's care plan.
- Maintains the patient's right to privacy and protects company operations by keeping information confidential.
- Promotes appropriate utilization of benefits.
- Participates in all health plan audit preparation.
- Participates in all health plan seminars and training as applicable.
- Develop a working relationship with internal departments to maintain the flow of needed information.
- Submit reports and statistics as applicable.
- Performs other duties and tasks as assigned.
- Active and unrestricted California Licensed Vocational Nurse (LVN) license.
- Experienced in managed care environment to include but not limited to health plan, IPA or MSO preferred.
- Experience with clinical issues, clinical guidelines, case management, & managed care.
- Basic knowledge of DHS, DMHC, NCQA, and CMS standards.
- Excellent analytical critical reasoning and interpersonal communication skills.
- Excellent written and oral communication skills, as well as strong interpersonal, critical thinking and analytical skills.
- Excellent organizational, decision-making and multi-tasking skills.
- Must be able to work autonomously utilizing all resources available while staying within the boundaries of duties but also as a team member.
- 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).
Astrana Health is proud to offer a competitive compensation package, including a total compensation target pay range of $30.00 - $35.00 per hour. We are an equal opportunity employer and welcome applications from diverse candidates.
We are committed to creating a workplace that is inclusive and respectful of all employees. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
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