Case Manager - LVN

Astrana Health, Inc.•Monterey Park, CA

10d•$30 - $35•Hybrid

About The Position

The Case 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 HMO and ACO members 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. Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team

Requirements

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 TX
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
Proficient with Microsoft Office (Word, Excel, Power Point) and EZCAP
Bilingual in Mandarin/Cantonese or Spanish, preferred

Nice To Haves

1+ years 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

Responsibilities

Comply with Astrana and department policies and procedures
Assessment of the medical, social, and behavioral needs of the 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 progressions and 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/participate in company meetings, team meetings, and MDT meetings.
Other duties and tasks assigned