Case Manager (Bilingual - Spanish)

Astiva Health•Orange, CA

1d•$75,000 - $90,000•Onsite

About The Position

Astiva Health, Inc. is seeking a highly energetic and collaborative ambulatory case manager to join their team in Orange, CA. This role, reporting to the Case Management (CM) Manager, is crucial for facilitating patient care plans across the continuum. The primary objective is to ensure appropriate utilization management, care coordination, resource utilization, and clinical documentation in line with the Model of Care and CMS regulations. The Ambulatory Case Manager (ACM) will operate within the Astiva Case Management department, taking responsibility for assessing, planning, implementing, evaluating, and communicating patient care plan progression. Utilizing principles of mutual respect and member/family advocacy, the ACM will coordinate with internal partners and external agencies to achieve optimal clinical, financial, and member satisfaction outcomes.

Requirements

Active LVN/RN license required.
3 or more years of Case Management experience required.
Bilingual in Spanish (verbal and written)

Nice To Haves

Registered Nurse with Active unrestricted CA RN license preferred.
Experience with Microsoft Excel, PowerPoint, Outlook, Teams preferred.

Responsibilities

Monitor, evaluate and develop plan of care from members’ Health Risk Assessment (HRA)
Assess members’ physical, mental and socioeconomic wellness, needs, preferences and abilities to develop a comprehensive, member-centric plan of care.
Coordinate with the members of Interdisciplinary Care Team (ICT), members, and any other applicable teams to develop, update and maintain members’ Individualized Care Plan (ICP)
Proactively identify members who are at-risk for a potentially avoidable adverse medical event or at-risk for developing complex needs during an acute episode of illness.
Coordinate with treating providers to ensure member receives the medical care and support services needed and that communication and information-sharing is effective and timely between all involved providers.
Improve member and provider satisfaction through the collaboration, coordination, and management of health care resources.
Facilitate individuals’ health system navigation and the receipt of needed medical services, improve individual’s self-management and overall health functioning, coordinate care among multiple providers, and mitigate medical risk (reduces hospitalization, readmission and ED visit rates and lowers healthcare costs).
Actively provide eligible members and their families (and if appropriate caregivers), the knowledge, skills, and resources needed to optimally partner with their providers and self-manage the chronic condition(s) or medically complex condition between provider visits.
Adhere to company policies and procedures regarding confidentiality and privacy
Maintain regular and consistent attendance
Perform other duties as assigned.