Care Manager - RN (ACM)

Astrana Health, Inc.•Houston, TX

4d•$80,000 - $94,000•Hybrid

About The Position

We are looking for a compassionate and experienced Care Manager - RN to join our Houston team. In this role, you will provide comprehensive care management and coordination for members across the continuum of care, partnering with providers, interdisciplinary teams, and community resources to improve clinical outcomes, enhance quality of care, and support members with complex medical, behavioral, and psychosocial needs.

Requirements

Associate degree in Nursing required
Texas RN unrestricted active license
At least 2 years of clinical nursing experience (case management, acute care, medical group, health plan, or managed care preferred)
Active, unrestricted Registered Nurse (RN) license
Strong clinical background must be familiar with developing care plans and assessments
Experience with Microsoft Office Word
Understanding of regulatory standards (CMS, NCQA, etc.).
Ability to assess and manage complex clinical and psychosocial situations
Excellent communication, collaboration, and critical-thinking skills
Proficiency in electronic health records (EHR) and care management documentation systems
Ability to manage multiple priorities in a fast-paced environment

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred
Able to work independently and make independent decisions
Ability to work prioritize and multi-task
Excellent written and verbal communication skills
Maintain courteous professional attitude when working with internal and external customers
Maintains member confidence and protects operations by keeping claim information confidential in compliance with HIPAA requirements

Responsibilities

Conduct comprehensive health assessments, including medical, behavioral, and social determinants of health (SDOH).
Develop, implement, and evaluate individualized care plans based on member needs, goals, and risk level.
Coordinate care across multiple settings, including inpatient, outpatient, and community-based services.
Facilitate transitions of care, including hospital discharge planning and post-discharge follow-up.
Utilize clinical expertise to identify gaps in care, potential risks, and opportunities for early intervention.
Monitor member progress and adjust care plans accordingly.
Provide education to members and caregivers regarding disease management, medications, and treatment plans.
Apply evidence-based guidelines and best practices in care management.
Support appropriate utilization of healthcare services to ensure cost-effective care delivery.
Collaborate with utilization management teams to reduce avoidable hospitalizations and emergency department visits.
Identify high-risk members and implement strategies to improve outcomes and reduce healthcare costs.
Partner with physicians, specialists, behavioral health providers, and community agencies to coordinate care.
Serve as a liaison between members, providers, and health plan resources.
Participate in interdisciplinary team meetings and case conferences.
Maintain effective communication to ensure continuity of care.
Ensure timely and accurate documentation in accordance with regulatory, CMS, and organizational requirements.
Support quality improvement initiatives, including HEDIS, STAR ratings, and other performance measures.
Maintain compliance with accreditation standards and internal policies.
Conduct outreach to engage members in care management programs.
Promote self-management and adherence to treatment plans.
Address barriers to care, including social, economic, and cultural factors.