Job Title: Care Manager
Department: Health Services
What You’ll Do
- Develop and initiate client-centred, comprehensive Individual Care Plans consistent with programme guidelines, policies and procedures.
- Identify, arrange and monitor appropriate community services, using strong knowledge of Medicare, Medicaid and other entitlement programmes.
- Coordinate and facilitate patient care through assessment, evaluation, planning and implementation, communicating needs to the care team and following up as required.
- Manage discharge plans and work collaboratively with patients, families, physicians and nurses to ensure high-quality care.
- Act as the patient’s advocate regarding insurance coverage and financial assistance.
- Maintain a comprehensive clinical record through detailed, accurate documentation.
- Coordinate an interdisciplinary approach to support timely access to appropriate care, ensure continuity among providers and optimise use of resources.
- Apply established care transition principles, following members through the continuum of care and coordinating warm hand-offs to appropriate providers and/or health plans.
- Assist the UM Manager and participate in all internal and external audits.
- Serve as primary liaison with contracted health plans for case management activities.
- Protect the privacy and security of PHI in line with Medical Group/MSO policies and HIPAA requirements.
- Perform other duties and special projects as assigned.
Qualifications:
- Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN) required
- Two (2) years’ utilization management experience applying evidence-based clinical criteria and benefit plans required
- Three (3) years’ clinical experience, preferably in case management or a related area, required
You're great for the role if:- Bachelor’s degree in nursing or a related health services field
- Certified Case Manager (CCM) certification preferred
- Tagalog or Ilocano language skills preferred
Environmental Job Requirements and Working Conditions
- This is a remote position. This position is based in the Maryland area.
- This position is required to visit provider offices and members in the Prince George's County, Maryland area.
- The total compensation target pay range for this role is: $30.00 - $34.00 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 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.
Salary: 30 - 34 USD per hour
