Case Manager (Bilingual - Spanish)

Astiva Health; California; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

401k

Dental Insurance

Health Insurance

Vision Insurance

Life Insurance

Paid Time Off

Free catered lunches

Job summary

Astiva Health, Inc. in Orange, CA, seeks an Ambulatory Case Manager to join the Case Management team.

Reporting to the CM Manager, you will coordinate care plans, ensure utilization management, and document progress across the care continuum in alignment with the Model of Care and CMS regulations. The ACM will work within an interdisciplinary team to assess, plan, implement, evaluate and communicate patient care, promote collaboration with providers, and improve outcomes and satisfaction for

Qualifications

• Registered Nurse with an active, unrestricted CA RN license preferred.
• Active LVN/RN license required.
• 3+ years of Case Management experience required.
• Experience with Microsoft Excel, PowerPoint, Outlook, Teams preferred.
• Bilingual in Spanish (verbal and written).

Responsibilities

• Monitor, evaluate and develop plan of care from members’ Health Risk Assessment (HRA).
• Coordinate with Interdisciplinary Care Team (ICT) and members to develop ICP.
• Identify at-risk members for potentially avoidable events or complex needs.
• Coordinate with treating providers to ensure needed medical care and timely information sharing.
• Improve member and provider satisfaction through effective resource management.
• Facilitate health system navigation and self-management for chronic conditions.
• Adhere to confidentiality and privacy policies; maintain consistent attendance.

Skills

Effective communication

Team collaboration

Bilingual Spanish

Education

Active CA RN license

LVN/RN license

3+ years of Case Management experience

Tools

Microsoft Excel

PowerPoint

Outlook

Teams

Job description

About Us:

Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our diverse community, we prioritize accessibility, affordability, and quality in all aspects of our services. Join us in our mission to transform healthcare delivery and make a meaningful difference in the lives of our members.

SUMMARY:

Astiva Health Inc is looking for a highly energetic and collaborative ambulatory case manager. This role will report to the Case Management (CM) Manager. The primary objective of the Ambulatory Case Manager (ACM) is to work within an interdisciplinary team to facilitate the patient plan of care throughout the continuum of care by ensuring appropriate utilization management, care coordination, resource utilization, and clinical documentation in accordance with the Model of Care and CMS regulations. The ACM will function within the Astiva Case Management department, which includes accountability for assessing, planning, implementing, evaluating, and communicating the patient care plan progression. The ACM utilizes the principles of mutual respect, member/family advocacy and coordinates within the team of internal partners and outside agencies to facilitate best practices, achieving quality clinical, financial, and member satisfaction outcomes.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Monitor, evaluate and develop plan of care from members’ Health Risk Assessment (HRA)
• Assessing members’ physical, mental and socioeconomic wellness, needs, preferences and abilities to develop a comprehensive, member-centric plan of care.
• Coordinate with the members of Interdisciplinary Care Team (ICT), members, and any other applicable teams to develop, update and maintain members’ Individualized Care Plan (ICP)
• Proactively identify members who are at-risk for a potentially avoidable adverse medical event or at-risk for developing complex needs during an acute episode of illness.
• Coordinate with treating providers to ensure member receives the medical care and support services needed and that communication and information-sharing is effective and timely between all involved providers.
• Improve member and provider satisfaction through the collaboration, coordination, and management of health care resources.
• Facilitates individuals’ health system navigation and the receipt of needed medical services, improves individual’s self-management and overall health Astiva Health, Inc. and functioning, coordinates care among multiple providers, and mitigates medical risk (reduces hospitalization, readmission and ED visit rates and lowers healthcare costs).
• Aims to actively provide eligible members and their families (and if appropriate caregivers), the knowledge, skills, and resources needed to optimally partner with their providers and self-manage the chronic condition(s) or medically complex condition between provider visits.
• Adhering to company policies and procedures regarding confidentiality and privacy
• Regular and consistent attendance
• Other duties may be assigned.

BENEFITS:

• 401k
• Dental Insurance
• Health Insurance
• Vision Insurance
• Life Insurance
• Paid Time Off
• Free catered lunches

Requirements

EDUCATION and/or EXPERIENCE:

• Registered Nurse with Active unrestricted CA RN license preferred.
• Active LVN/RN license required.
• 3 or more years of Case Management experience required.
• Experience with Microsoft Excel, PowerPoint, Outlook, Teams preferred.
• Bilingual in Spanish (verbal and written)

OTHER SKILLS and ABILITIES:

• Effective communication skills to manage a team. Ability to work both independently and, in team-oriented, collaborative environments.