Care Manager - Home Care (RN)

Department: Health Services

Location: 1600 Corporate Center Dr., Monterey Park, CA 91754

Compensation: $93,000 - $114,000 / year

Description

We are seeking an experienced and compassionate Registered Nurse (RN) to join our Home Care Program as a Care Manager for high-risk patients. In this role, you will provide essential care management, conduct home visits, and offer palliative care to individuals with complex health needs, chronic illnesses, and life-limiting conditions. Your goal will be to ensure optimal care coordination, enhance patient quality of life, and provide the support necessary for patients and their families to navigate complex healthcare needs at home. You will work closely with Home Care Nurse Practitioner to help deliver care to these members.

Our Values:

• Put Patients First


• Empower Entrepreneurial Provider and Care Teams


• Operate with Integrity & Excellence


• Be Innovative


• Work As One Team

What You'll Do

Care Management:

• Develop and implement individualized care plans for high-risk patients, focusing on improving health outcomes and preventing hospital admissions, readmissions and ER visits.


• Coordinate patient care with interdisciplinary teams, including physicians, social workers, therapists, and other healthcare professionals.


• Monitor patient progress, track health metrics, and adjust care plans as needed based on changes in patient condition.


• Provide advocacy and support to patients and families, ensuring access to necessary healthcare resources and services.


• Educate patients and families on disease management, self-care, medication adherence, and healthy lifestyle practices.

Home Visits:

• Conduct comprehensive in-home assessments to evaluate the physical, emotional, and social needs of patients.


• Perform hands-on care interventions, including medication management, and monitoring vital signs.


• Assess the home environment for safety and implement changes or recommendations to promote patient safety and independence.


• Provide education and training to patients and caregivers on managing chronic conditions, understanding medical treatments, and recognizing warning signs that require urgent care.


• Work with Home Care NP to ensure that the home care plan is followed, adapting it to the patient's evolving needs and conditions.

Palliative Care:

• Collaborate with the Home Care NP to offer holistic care to patients with serious or life-limiting conditions.


• Manage and monitor symptoms such as pain, nausea, shortness of breath, and other distressing symptoms to improve patient comfort and quality of life.


• Provide emotional and psychological support to patients and their families, addressing the mental and emotional challenges that come with serious illness.


• Educate patients and families about palliative care options, including advanced care planning, end-of-life care, and decision-making.


• Assist patients and families in navigating difficult conversations regarding prognosis, treatment options, and goals of care.

Patient Education and Empowerment:

• Offer in-depth education on managing chronic illnesses, medication management, and available community resources.


• Empower patients and their caregivers by helping them make informed decisions about their care and providing tools to manage their conditions effectively at home.


• Offer counseling and support to help patients and families adjust to the challenges associated with chronic illness or end-of-life care.

Documentation and Reporting:

• Maintain accurate and up-to-date patient records in compliance with organizational standards and regulatory requirements.


• Document patient assessments, care interventions, progress, and any changes in condition in a timely manner.


• Report critical findings and concerns to the physician, family members, and other team members as appropriate.


• Ensure proper billing documentation for services rendered, adhering to home health regulations and insurance requirements.

Collaboration and Teamwork:

• Work closely with the multidisciplinary care team, including physicians, social workers, care coordinators, and family caregivers to coordinate patient care.


• Participate in regular team meetings to discuss patient progress, challenges, and updates to care plans.


• Contribute to continuous improvement initiatives within the home care program to improve patient outcomes and satisfaction.

Qualifications

• Active and unrestricted CA RN license


• Palliative Care Nursing Certification (CHPN) preferred, or willingness to pursue


• Care Management Certification (CCM) preferred


• Strong clinical assessment, critical thinking, and problem-solving skills.


• Ability to independently manage patient care in a home setting


• Excellent communication and interpersonal skills, with the ability to build trusting relationships with patients and families


• Compassionate, patient-centered approach to care, especially for those with chronic or terminal illnesses


• Proficiency in using electronic health records (EHR) and other office software


• Knowledge of community resources, healthcare services, and support programs for patients with chronic and life-limiting condition


• Bilingual Cantonese/Mandarin is a plus!

Environmental Job Requirements and Working Conditions

• This is a hybrid position where you will work at home, in the office, and in the field on a weekly basis. The office is located at 1600 Corporate Center Drive in Monterey Park, CA. Home visits will be required across the San Gabriel Valley.


• The total compensation target pay range for this role is between $93,000 - $114,000 annually. This pay range represents our national target range for this role. Total compensation will be evaluated based on experience, certifications, and skillsets.

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 [email protected] 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.

About Astrana HealthAstrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient.

Our platform currently empowers over 10,000 physicians to provide care for over 1 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.