Care Manager I – RN

Job Title: Care Manager Department: Population Health What You’ll Do• Develops and initiates the Individual Care Plan, which is client-centered, com prehensive and consistent with p rog ram guidelines and policies and procedures • Identifies, arranges for, and monitors appropriate community services based on a good 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, and nurses 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 member 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 UM 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, Licensed Vocational Nurse, or Medical Assistant required • Bachelor’s degree in nursing and or a related health services field is preferred • At least two (2) years’ experience in utilization management including experience applying evidenced based clinical criteria and benefit plans is required • At least three (3) years’ of clinical experience preferably in case management or related experience is required You’re great for the role if: • Have a certification as Certified Case Management (CCM) • Are fluent in Tagalog or Ilocano Environmental Job Requirements and Working Conditions• This is a remote position.

Source: https://himalayas.app/companies/astrana-health/jobs/care-manager-i-rn