ECM Case Manager

Monterey Park, NM - USA

Hourly Salary: $ 28 - 38

Posted on: 11 hours ago

Vacancies: 1 Vacancy

Job Summary

We are currently seeking a highly motivated LVN Lead Care Manager for our Enhanced Care Management (ECM) team. ECM is a Medi-Cal benefit that links high risk members to various resources in the community. You will be responsible for doing assessments and creating care plans based on those assessments for your caseload. The ECM Case Managers goal is to improve health outcomes reduce health disparities and enhance continuity of care for high-need Medi-Cal enrollees including those with chronic health conditions behavioral health needs substance use disorders or who are experiencing homelessness or frequent hospitalizations. This role will report to the Manager of Strategy & Operations. This is a hybrid role where the expectation is to work both in office and at home on a weekly basis.

What Youll Do

Manage a collective caseload of 250 members with complex needs
Conduct outreach complete initial comprehensive assessments within specific timeframes per health plan requirements care planning and risk stratification
Coordinate transitions of care including post-hospital/SNF follow-ups
Review claims authorizations and perform medication reconciliations
Connect members to social services transportation and community resources
Utilize motivational interviewing trauma-informed care and harm-reduction approaches
Collaborate with hospital staff and interdisciplinary teams for care coordination
Identify barriers to treatment adherence and adjust care plans accordingly
Educate members/caregivers on disease management and healthcare navigation
Support members telephonically and participate in audits and team meetings
Monitor member progress regularly on a weekly cadence adjusting care plans as needed to meet evolving needs
Track monitor and manage caseload activity on a weekly cadence ensuring deliverables and outcomes are met
Demonstrate proficiency in juggling multiple systems and platforms with strong working knowledge of Excel for tracking reporting and analysis
Provide telephonic member support and participate in audits quality reviews and team meetings as required

Qualifications

Active and unrestricted LVN license
Experience with telephonic case management
Ability to learn and utilize case management software and health plan portals
Excellent analytical critical reasoning organizational and interpersonal communication skills
Strong written and oral communication skills
Ability to multi-task work autonomously and think outside the box
Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers members business plans strategies and other sensitive information is required
High level of regard for undeserved communities

Youre great for the role if:

Bilingual Spanish
Knowledge of Enhanced Care Management SNP case management complex case management
Experience in managed care environment health plans IPA or MSO
Utilization Management or Hospice CM experience
1 years of Case Manager experience
Basic knowledge of DHCS DMHC NCQA ICE and CMS standards

Environmental Job Requirements and Working Conditions

Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr Monterey Park CA 91754.
The total compensation target pay range for this role is: $28.84 - $38.46 per hour. Actual compensation will be determined based on geographic location (current or future) experience and other job-related factors.
The first month of training will be fully in-office then the expectation will be to work two days a week in office (W/Th) and the rest of the week from home. Working hours are between Monday through Friday between 8:30 AM - 5:00 PM.

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 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.

Required Experience:

Manager