Care Manager I - RN

Job Title: Care Manager
Department: Population Health

What You'll Do

• Develops and initiates the Individual Care Plan, which is client-centered, com prehensive and consistent with p rog ram guidelines and policies and procedures
• Identifies, arranges for, and monitors appropriate community services based on a good knowledge of Medicare, Medicaid, and other entitlement programs
• Coordinate and facilitate patient care through assessment, evaluation, planning, and implementation
• Communicate patient needs to a variety of care team members and follow up accordingly
• Manage discharge plans upon completion of treatment
• Work collaboratively with patients, families, physicians, and nurses to ensure high quality care
• Act as the patient's advocate as it relates to insurance coverage and financial assistance
• Maintain the patient's comprehensive clinical record through detailed documentation
• Coordinate an interdisciplinary approach to support timely access to appropriate care, facilitate continuity of care among providers and improve utilization of appropriate resources
• Apply established principles of care transition and follow member through continuum of care as well as coordinate a warm hand-off to the appropriate provider and/or health plan for necessary involvement of continuation of care and services
• Assists UM Manager and participates in all internal and external audits
• Primary liaison with all contracted health plans for case management activities
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in Medical Group/ MSO policies and procedures related to HIPAA compliance
• Other duties and special projects as assigned

Qualifications

• Registered Nurse, Licensed Vocational Nurse, or Medical Assistant required
• Bachelor’s degree in nursing and or a related health services field is preferred
• At least two (2) years’ experience in utilization management including experience applying evidenced based clinical criteria and benefit plans is required
• At least three (3) years’ of clinical experience preferably in case management or related experience is required

You're great for the role if:

• Have a certification as Certified Case Management (CCM)
• Are fluent in Tagalog or Ilocano

Environmental Job Requirements and Working Conditions

• This is a remote position. The home office is located at 1600 Corporate Center Dr., Monterey Park, CA 91754.
• The total compensation target pay range for this role is: $78,000 - $91,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

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 to request an accommodation.

Additional Information: 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.

Originally posted on Himalayas