Care Manager I – LVN

Role Overview

• 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.
• Participate in special projects and perform other duties as assigned.

Requirements

• Active LVN license in the State of Texas required.
• Minimum of three (3) years of clinical nursing experience, preferably in case management, care coordination, population health, utilization management, or a related healthcare setting required.
• Minimum of three (3) years of hospital, acute care, or inpatient experience strongly preferred.
• Minimum of two (2) years of utilization management experience, including application of evidence-based clinical criteria and health plan benefits.
• Knowledge of Medicare, Medicaid, managed care, and community-based resources.
• Strong assessment, care coordination, documentation, and communication skills.
• Proficiency with electronic health records (EHRs) and care management systems.
• Certified Case Manager (CCM) certification preferred.
• Experience working within value-based care, managed care, ACO, IPA, MSO, or population health environments preferred.

Benefits

• This is a full-time remote role requiring a minimum of one monthly in person team meetings at the Houston office, located at 9500 HWY 249, Suite 570 Houston, TX 77070.
• The total compensation target pay range for this role is $60,000
• 74,000 annually.
• Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer.
• We do not discriminate based on 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 based on 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.
• 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.