Case Manager at Astiva Health – Orange, California

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

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.

OTHER SKILLS and ABILITIES:

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