Astrana Health Careers

Description

• 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 evaluates 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)

• 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.

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

• 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.