Job Title: ACM Case Manager, LVN
Department: Health Services - ACM
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 compliant with Model of Care and Training.
What You'll Do:
- Assess identified members in a timely fashion to ensure appropriate assessment and individualized care plans are developed with the member according to the requirements in the Model of Care and training.
- Based upon care management criteria, contact and completes assessments for members identified as potential candidates for care management.
- Evaluates assessment findings against evidenced-based guidelines to develop a plan of care based on member 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 member.
- Educates member/caregiver on specific disease using approved evidence-based guideline and; using clinical judgement, modifies plan of care/goals based on member’s readiness to change.
- Facilitates care coordination across the care continuum (home, hospital, home health), identifies community resources and makes referrals as appropriate.
- Contact members after hospital discharge to perform assessment and complete medication reconciliation. Provide education, coordination of care, and follow up to prevent readmission.
- Encourage members 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 member according to the training.
- Attends/participates in interdisciplinary team meetings.
- Provides enrollee with support telephonically.
- Be available to participate in on-call schedule.
- Attends/participates in staff meetings.
- Participates in all health plan audit and preparation as applicable.
- Participates in all health plan seminars and training as applicable.
- Develop a working relation with internal departments to maintain the flow of needed information.
- Submit reports of productivity as applicable.
- Maintains the member’s right to privacy and protects Astrana Health operations by keeping information confidential.
Qualifications:
- Current and active California license, LVN.
- Experienced in managed care environment to include but not limited to health plan, IPA or MSO.
- Experience with clinical issues, clinical guidelines, case management, & managed care.
- 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).
You're great for this role if:
- Bilingual - fluent in Chinese (Cantonese and/or Mandarin).
- 1+ years of Case Manager experience.
- Basic knowledge of ICE, DHS, DMHC, NCQA, and CMS standards.
- Previous experience of Case Management including BCM, CCM, SNP, ECM.
Who We Are:
Astrana Health 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 ~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 Center Drive, Monterey Park, CA 91754.
- The total compensation target pay range for this role is between $30.00 - $35.00 per hour. The salary range represents our national target range for this role.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
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