ACM Case Manager I - LVN

Job Description

Job Description

Description

As a Disease Management Case Manager, you will provide a wide range of services, including telephonic health education for patients with chronic health conditions, coordinating care with various healthcare professionals, and promoting the use of health products. You will also assess and coordinate delivery of care in various facilities and provide education on managing disease processes. Additionally, you will conduct process and outcome evaluations of chronic disease programs and monitor the effectiveness of care management plans.

What You'll Do

• Complies with company and department policies & procedures to ensure all appropriate assessments for the eligible population are completed and acted upon within established timeframes.
• Responsible for reviewing Health Plan reports / requests / HRA for new patients assigned to Coordination of Care, Basic Case Management, Complex Case Management, and SNP
• Responsible for the care management (coordination of outpatient care) of patients with catastrophic illnesses and chronically ill while ensuring the quality-of-care standards are met by using clinical judgment to assess and / or evaluate.
• Caseload : Minimum contact   10 cases per day
• Responsible to identify and evaluates patients for enrollment into one of the case management programs : complex case management, SNP, Transplant, BCM, patient education, ESRD…etc. and update progress to various health providers (including but not limited to health plan, physician, and patient) to ensure compliance.
• Conducts telephonic assessments to identify patients’ medical, physical, and psychosocial needs.
• Assess identified patients in a timely fashion to ensure appropriate individualized care plans are developed with the member to eliminate or reduce unnecessary admissions / re-admissions.
• Based upon care management criteria, contact and complete assessments for patients identified as potential candidates for disease management.
• Evaluates assessment findings against evidenced-based guidelines to develop a plan of care based on patient needs and findings with collaboration from the interdisciplinary team.
• Identifies potential barriers to adherence to treatment plan and modifies plan by mutual agreement with the patient
• Educates patient / caregiver on specific disease using approved evidence-based guideline and using clinical judgment, modifies plan of care / goals based on patient’s readiness to change.
• Facilitates care coordination across the care continuum (home, hospital, home health, outpatient, etc.), identifies community resources, and makes referrals as appropriate.
• Encourage patients to take an active role in both chronic disease and health prevention utilizing self-management support and patient education.
• Discuss self-management goals with the patient and assists them in selecting appropriate goals.
• Assesses cultural and linguistic needs and preference
• Consistently documents activities and interventions provided to the patient.
• Attends / participates in staff meetings and interdisciplinary team meetings.
• Prepares and presents cases in Interdisciplinary Care Team meetings.
• Evaluates assessment finding, develops case presentation for the Interdisciplinary Care Team (ICT), and incorporates ICT recommendations into the patient’s care plan.
• Maintains the patient’s right to privacy and protects company operations by keeping information confidential.
• Promotes appropriate utilization of benefits
• Participates in all health plan audit preparation.
• Participates in all health plan seminars and training as applicable.
• Develop a working relationship with internal departments to maintain the flow of needed information.
• Submit reports and statistics as applicable.
• Performs other duties and tasks as assigned.

Qualifications

You’re great for the role if you have :

Environmental Job Requirements and Working Conditions

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.

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 - $40