ECM Case Manager - LVN (LA Region)

Astrana Health, Inc.•Monterey Park, CA

3d•$32 - $37•Hybrid

About The Position

The ECM Case Manager (LVN) provides clinically informed care management, under the supervision and direction of the Manager, Strategy & Operations and RN Clinical Consultant, to a caseload of high-need Medi-Cal members enrolled in Astrana Health’s Enhanced Care Management (ECM) program. The role supports members with chronic health conditions, behavioral health needs, substance use disorders, homelessness, or frequent hospitalizations by coordinating care, closing gaps in services, and connecting members to clinical and community-based resources. The ECM Case Manager works cross-functionally with internal teams, community-based organizations, and health plan partners to improve health outcomes, reduce health disparities, and support continuity of care. The position advances the ECM program’s quality, compliance, and member engagement goals. It is based in a hybrid work structure, with work both in the office and at home on a weekly basis, and occasional weekly field visits to homes and community-based settings.

Requirements

At least 2 years of clinical experience, such as in a skilled nursing facility, home health, hospice, case management, or care coordination.
Current, active, and unrestricted Licensed Vocational Nurse (LVN) license in the State of California.
Ability to learn and navigate multiple case management software platforms and health plan portals while maintaining data accuracy.
Strong analytical, critical reasoning, organizational, and interpersonal communication skills.
Strong written and verbal communication skills.
Ability to multitask, work autonomously, and exercise sound clinical judgment.
Ability to maintain confidentiality and discretion when handling sensitive member, provider, and business information.

Nice To Haves

Associate’s or Bachelor’s degree in a health or human services-related field; an equivalent combination of education and progressively responsible clinical experience will be considered.
Familiarity with care plan goal setting, including developing problem statements, interventions, and goals.
Bilingual in Spanish.
Experience in a managed care environment, such as a health plan, IPA, or MSO.
Utilization Management or Hospice Case Management experience.
Working knowledge of DHCS, DMHC, NCQA, and CMS standards.

Responsibilities

Manage an assigned caseload of members with complex medical, behavioral, and social needs across multiple health plan contracts.
Conduct outreach for members regardless of case assignment or health plan to support ECM program engagement goals.
Meet with members in person, including through home visits, provider office visits, and community-based settings, to build trust, complete assessments, review care plans, and support engagement.
Complete initial comprehensive assessments, care plans, and interdisciplinary team conferences within timeframes set by ECM leadership.
Develop member-centered care plans with clear, measurable, achievable goals and review and update them regularly based on member progress.
Support the RN Care Manager with clinical assessments, including comprehensive health assessments, medication reconciliation, post-hospital discharge assessments, and standardized screening tools such as PHQ-9, GAD-7, and the Edinburgh Postnatal Depression Scale.
Maintain accurate and timely documentation in case management software, Excel trackers, Monday.com boards, and health plan portals.
Coordinate transitions of care, including post-hospital and skilled nursing facility follow-up.
Communicate with PCPs, specialists, behavioral health providers, hospitals, and community-based organizations to close the loop on referrals and prevent gaps in care during transitions.
Review claims and authorizations and perform medication reconciliation in support of care coordination.
Work with internal and external partners to support ECM program success and support members across all contracted health plans in addition to managing an individual caseload.
Connect members to social services, transportation, housing, food, and other community resources.
Apply motivational interviewing, trauma-informed care, and harm-reduction approaches to support member engagement.
Identify barriers to treatment adherence and adjust care plans accordingly.
Educate members and caregivers on disease management and healthcare navigation.
Monitor member progress and caseload activity weekly, ensuring deliverables and outcomes are met.
Participate in audits, quality reviews, and team meetings as required.
Maintain accurate and honest timekeeping.
Support fellow care managers by sharing best practices and contributing to a positive, accountable team culture.
Perform other duties as assigned.