Case Management Director jobs in Orange, CA

Job Title: Case Management Manager
Target Compensation Range: $120,000-$150,000/year, depending on relevant qualifications and experience

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.

Astiva Health, Inc. is looking for a highly energetic and collaborative Case Management Manager. This role will report to the UM/CM Director. The primary objective of the CM Manager is to foster an environment of excellence in servicing Astiva Health's members. This includes extensive interaction with client organizations and multiple stakeholders, delivering a high-quality CM operation meeting and exceeding all service level agreements and KPIs, driving operational excellence, and building competencies for delivery.

ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned.

• Performing ad hoc CM functional audits and delegation oversight audits, if applicable.
• Lead orientation and training for new Case Management staff related to managing role/workflow expectations.
• Leads and oversees CM functions and team, engaging with and assisting identified members to complete the HRA, develop the Individualized Care Plan, establish individual goals, manage chronic conditions, improve care coordination and access to needed care and resources.
• Provide feedback related to productivity and caseload management opportunities.
• Adhering to company policies and procedures regarding confidentiality and privacy.
• Providing case management services and providing supervision and leadership.
• Responsible for directly managing the CM team or as defined by the CM Director.
• Manage each team member of the Case Management team through frequent communication, case reviews, performance evaluations, onsite assistance, and as a resource as needs arise.
• Perform case reviews of Case Management Nurses and Coordinators, evaluating policy/protocol adherence, interdisciplinary team collaboration, and regulatory compliance for program enrolled populations.
• Includes ongoing collaboration and communication with providers, clinical staff, case managers, and clients utilizing collaborative care planning when appropriate.
• Perform duties of Case Manager when needed.
• Other duties may be assigned.

QUALIFICATIONS REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

QUALIFICATIONS REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, including regular and consistent attendance. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUATION 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.
• 2 or more years of supervisory, management or team lead experience required.
• Experience with Microsoft Excel, PowerPoint, Outlook, Teams preferred.

LANGUAGE: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups and customers or employees of the organization.

MATHEMATICS: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form.

OTHER SKILLS and ABILITIES:

EEO/AFFIRMATIVE ACTION STATEMENT: It is the policy of Astiva Health to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law. This policy relates to all phases of employment, including but not limited to recruiting, employment, placement, promotion, transfer, demotion, reduction of workforce and termination, rates of pay or other forms of compensation, selection for training, the use of all facilities, and participation in all company sponsored employee activities. Provisions in applicable laws providing for bona fide occupational qualifications, business necessity or age limitations will be adhered to by the organization where appropriate. Please refer to Standard Operating Procedure 100 for more information about the organization’s Affirmative Action/EEO statement.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit and complete work while on a computer. The employee occasionally is required to stand, walk, use hands to finger, handle or feel, reach with hands and arms, stoop, kneel, crouch or crawl, climb or balance, talk and hear.

While performing the duties of this job, the employee is occasionally required to lift or exert force up to 10 pounds.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Type: Full-time

Pay: $120,000.00 - $150,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Application Question(s):

• This position is based in the Orange, CA offices, with no option for remote/hybrid work schedules. Are you looking and willing to commute into the office?

Experience:

• Case management: 3 years (Preferred)

License/Certification:

• RN License (Required)
• LVN License (Required)

Ability to Relocate:

• Orange, CA 92868: Relocate before starting work (Required)

Work Location: In person