Job Title: ACM Case Manager LVN (Disease Management) - Hybrid
Department: Health Services - ACM
*BILINGUAL CHINESE*
About the Role:
As a Disease Management Case Manager, you will provide a wide range of services, including telephonic health education for patients with chronic health conditions, coordinating care with various healthcare professionals, and promoting the use of health products. You will also assess and coordinate delivery of care in various facilities and provide education on managing disease processes. Additionally, you will conduct process and outcome evaluations of chronic disease programs and monitor the effectiveness of care management plans.
What You’ll Do:
- Complies 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.
- Responsible to 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 evidence-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.
- Encourages patients to take an active role in both chronic disease and health prevention utilizing self-management support and patient education.
- Discusses self-management goals with the patient and assists them in selecting appropriate goals.
- Assesses cultural and linguistic needs and preferences.
- 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 findings, 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.
- Develops a working relationship with internal departments to maintain the flow of needed information.
- Submits reports and statistics as applicable.
- Performs other duties and tasks as assigned.
Qualifications:
- 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).
You’re great for the role if you have:
- Previous experience with disease management of CHF, ESRD, COPD.
- Bilingual – fluent in Chinese (Cantonese and/or Mandarin) highly preferred.
- Ability to function independently under time constraints.
- Willingness to accept responsibility and desire to learn new tasks.
- Experience in SNP Case Management is preferred.
- Strong communication and customer service skills and respect for confidentiality.
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 ~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 Dr., Monterey Park, CA 91754.
- The total compensation target pay range for this role is: $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.
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
#LI-Hybrid
#J-18808-Ljbffr
