ECM Case Manager - RN

Department: HS - ACM

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Compensation: $40.00 - $50.00 / hour

Description

Astrana is seeking an RN Case Manager for our Enhanced Care Management (ECM) team. This RN Case Manager will provide efficient and effective telephonic care management to qualified ECM members by addressing their medical, physical and psychosocial needs. Using clinical judgement, you will develop, modify and assists the member in implementing their care plans. This position will entail a caseload of 50 members and offers a hybrid schedule, where you will work both at home and in the office on a weekly basis. There is no field work required in this position.

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 timeframe


• 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


• RN assists in care plan sign-offs

Qualifications

• Active and unrestricted RN CA license


• Experience with telephonic case management


• Ability to learn and utilize case management software and health plan portals


• 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

You're a great fit for this role if:

• Bachelor's degree


• Knowledge of Enhanced Care 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

Environmental Job Requirements and Working Conditions

• This is a hybrid position. The office is located at 1600 Corporate Center Dr, Monterey Park, CA 91754. The first month of training will be fully in-office, then the expectation will be to work two days a week in office and the rest of the week from home.


• This is a full-time position. Expects hours are M-F 8:30 AM - 5 PM.


• The target pay range for this role is $45 - $55 per hour. This 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 [email protected] 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.