Astrana Health Careers

Description

• Clinical Oversight and Consultation: Provide clinical oversight of ECM Health Risk Assessments, participating in the development and approval of patient-centered care plans, and actively consulting with Care Managers to review medical summaries, discharge orders, and appointment outcomes.
• Health Education and Outreach: Mentor and guide Lead Care Managers on how to offer health care education, particularly for acute health conditions and chronic disease management, while engaging with vulnerable populations through multidisciplinary meetings.
• Data-Driven Interventions: Utilize data to evaluate outcomes from targeted interventions for a designated patient cohort, assisting in the development and adjustment of care plans based on analysis and insights derived from this data.
• Program Expansion and Collaboration: Collaborate in expanding programming to address Social Determinants of Health (SDoH) and enhance connections to community-based organizations, dedicating focused time to program development and refinement.
• Multidisciplinary Collaboration: Lead and collaborate with a case management team and community health workers to ensure client/patient-centered care aligns with established Care Plans and health goals. Primary care providers and specialists will be involved in collaboration if needed.
• Regional Engagement and Coordination: Assist lead care managers with transitions of care ensuring seamless coordination with hospitals, behavioral health clinicians, primary care physicians, and other relevant providers to prevent readmissions and support transitions in care. Collaborate with ECM Specialist to address ADT alerts and post discharge coordination of care.
• Quality Improvement and Compliance: Engage in quality improvement efforts, including chart reviews, audits, case conferences, and implementation of preventive care and engagement activities to continuously enhance the delivery of care.
• Onboarding and Training: Onboarding new case managers and providing guidance and refresher training to existing staff
• Training Guides: Build on Library of training materials for staff using: Power point, Vizio. Whimsical, Canva. etc

• Valid Registered Nurse (RN) license in California
• Strong interpersonal skills and clinical problem-solving abilities.
• Can think outside the box
• Can work well independently 
• Can work well as a team
• Computer skills, including: Teams, Excel and filters, email communication and data summarization in spreadsheets.

• Enjoy Creating Careplans for member journey to optimal health
• Previous care management experience.
• Proficiency in Microsoft Office (Outlook, Teams, Word, Excel, Sharepoint)
• Knowledge of: Healthplan Navigation, UM, CM, DC planning, Transitions of care, Medication reconciliations,  EZCap, MCG (Milliman Care Guidelines)
• Experience working with vulnerable populations, including individuals with a history of trauma, socioeconomic stress, homelessness, or substance use disorders
• Experience working with health plans
• Knowledge of managed care functions
• Proficiency in data analysis and utilization for performance tracking and measurement.
• Strong care planning experience

• 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 between $35.00-45.00 per hour. The salary range represents our national target range for this role.