Case Manager (LVN) - Outpatient

Job Description

Job DescriptionDescriptionThe 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

What You'll Do

• 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

Qualifications

• 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

You're great for this role if:

• 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

Environmental Job Requirements and Working Conditions

• Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. Following a ~30 day introductory period of being fully onsite for training purposes, the hybrid schedule will consist of being in-office about 2 days per week.
• The office is located at 1600 Corporate Center Drive, Monterey Park, CA 91754
• Work hours: 8:00am-4:30pm or 8:30am-5:00pm
• The total compensation target pay range for this role is between $30.00 - $35.00 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditioos), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.