Care Manager I - LVN

Job Description

Job Description

Description

The Care Manager, LVN supports Astrana Health’s mission to improve patient outcomes by providing transitional care management, high-risk care management, and ongoing follow-up for members across multiple health plans and populations after hospital discharge. The nurse conducts clinical assessments, coordinates care, ensures medication safety, assists with closing quality gaps, and promotes member engagement through regular outreach and education. 

What You'll Do

• Comply with Astrana and department policies and procedures.
• Assess the medical, social, and behavioral needs of members.
• Complete comprehensive member assessments within required timeframes and identify individuals who may benefit from case management using clinical judgment, observed health or psychological changes, and assessment-driven triggers.
• Ensure timely, accurate, and complete documentation in all systems.
• Develop and implement an individualized case management plan in collaboration with the member, caregiver, social worker, physician and/or other involved healthcare professionals and the member’s support person to address member needs and goals.
• Collaborate with hospitalists, inpatient case managers, and discharge planners to establish safe discharge plans beginning at admission.
• Review medical records and/or other documentation to determine medical necessity.
• Conduct medication reconciliation post-discharge.
• Review medications for accuracy, missing medications, duplications, and potential interactions.
• Promote medication adherence through reminders, education, and barrier reduction.
• Close open quality measure gaps.
• Review member profiles and medical records to identify open care gaps and assist in closing the gaps when applicable.
• Attend and participate in company meetings, team meetings, and IDT meetings.
• Other duties and tasks as assigned.

Qualifications

• Active Licensed Vocational Nurse (LVN) license in California with the ability to become licensed in other states, including but not limited to, NV, AZ, and HI.
• Minimum 1 year of clinical experience (acute care, ambulatory, case management, or related).
• Experience in managed care environment to include but not limited to health plan, IPA or MSO.
• Proficiency with Microsoft Office applications and experience navigating electronic medical record (EMR), care management, or other healthcare technology platforms.

You're great for the role if:

• Bilingual in Mandarin/Cantonese or Spanish.
• At least 1 year of Case Manager experience. 
• Basic knowledge of ICE, DHS, DMHC, NCQA, and CMS standards. 
• Previous experience of Case Management including BCM, CCM, SNP, ECM, TOC/TCS. 
• You are comfortable working across multiple technology platforms, can efficiently navigate between systems, and are able to learn and adapt to new tools and workflows.

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 Drive, Monterey Park, CA 91754.
• This role may require travel to member's homes and hospitals in the surrounding SGV area.
• The total compensation target pay range for this role is between $30.00 - $35.00 per hour. 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 View email address on click.appcast.io 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.