Care Manager, RN

Job Title: Care Manager

Department: Health Services - ACM

What You’ll Do:

• Develops and initiates the Individual Care Plan, which is client-centered, comprehensive and consistent with program guidelines and policies and procedures
• Identifies, arranges for, and monitors appropriate community services based on a working knowledge of Medicare, Medicaid, and other entitlement programs
• Coordinate and facilitate patient care through assessment, evaluation, planning, and implementation
• Communicate patient needs to a variety of care team members and follow up accordingly
• Manage discharge plans upon completion of treatment
• Work collaboratively with patients, families, physicians, nurses, and the multidisciplinary team to ensure high quality care
• Act as the patient's advocate as it relates to insurance coverage and financial assistance
• Maintain the patient's comprehensive clinical record through detailed documentation
• Coordinate an interdisciplinary approach to support timely access to appropriate care, facilitate continuity of care among providers and improve utilization of appropriate resources
• Apply established principles of care transition and follow patient through continuum of care as well as coordinate a warm hand-off to the appropriate provider and/or health plan for necessary involvement of continuation of care and services
• Assists Care Management Manager and participates in all internal and external audits
• Primary liaison with all contracted health plans for case management activities
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in Medical Group/ MSO policies and procedures related to HIPAA compliance
• Other duties and special projects as assigned

Qualifications:

• Registered Nurse required
• Bachelor’s degree in nursing and or a related health services field is preferred.
• Two (2) years’ experience in utilization management including experience applying evidenced based clinical criteria and benefit plans is required
• Three (3) years’ of clinical experience preferably in case management or related experience is required

You're great for this role if:

• You have a certification as Certified Case Management (CCM) 

Who We Are:
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost- effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 10,000 physicians to provide care for  over 1 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.

Our Values:

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

Environmental Job Requirements and Working Conditions:

• This position is remotely based in the U.S.
• The total compensation target pay range for this role is: $30.00 - $38.00 per hour. The salary range represents our national target range for this role.

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 conditions), 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.