Care Manager I - RN

Astrana Health, Inc.•Monterey Park, CA

1d•$78,000 - $91,000•Remote

About The Position

The Care Manager I - RN position is within the Population Health Department and is a full-time role. The primary responsibility is to develop and initiate client-centered, comprehensive Individual Care Plans consistent with program guidelines. This role involves identifying, arranging, and monitoring community services, with a strong understanding of Medicare, Medicaid, and other entitlement programs. The Care Manager will coordinate and facilitate patient care through assessment, evaluation, planning, and implementation, communicating patient needs to the care team and managing discharge plans. Collaboration with patients, families, physicians, and nurses is essential to ensure high-quality care. The role also involves acting as a patient advocate for insurance coverage and financial assistance, maintaining comprehensive clinical records through detailed documentation, and coordinating an interdisciplinary approach to support timely access to care and improve resource utilization. The Care Manager will also apply principles of care transition, follow members through the continuum of care, and coordinate warm hand-offs to appropriate providers. Additionally, the role includes assisting the UM Manager with audits, serving as the primary liaison with contracted health plans for case management activities, and ensuring the privacy and security of Protected Health Information (PHI) in compliance with HIPAA. Other duties and special projects may be assigned.

Requirements

Registered Nurse, Licensed Vocational Nurse, or Medical Assistant required
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

Nice To Haves

Bachelor’s degree in nursing and or a related health services field is preferred
Have a certification as Certified Case Management (CCM)
Are fluent in Tagalog or Ilocano

Responsibilities

Develops and initiates the Individual Care Plan, which is client-centered, comprehensive and consistent with program 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