About this role
About the Role We are currently seeking a highly motivated Manager, Care Management to support our Health Services Outpatient Care Management team at Astrana Health. This role is responsible for managing telephonic and in-home Care Management services and activities for high-risk patients, with the primary goal of preventing unnecessary utilization and improving patient outcomes. This position will lead a multidisciplinary clinical team, including providers, registered nurses, social workers, community health workers, and care coordinators. The ideal candidate is a strong people leader with deep care management expertise, a passion for serving complex patient populations, and a commitment to advancing value-based care. Our Values Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team Manage clinical services, including oversight of clinical policies, procedures, and daily activities of clinical team staff Ensure adequate staffing to conduct care management activities and effectively distribute workloads Ensure team members receive appropriate training to serve the population and demonstrate effective engagement activities for individuals with various disabilities, including chronic physical and behavioral health conditions Ensure Integrated Clinical Services staff are trained on NCQA and HEDIS measures and processes to maintain compliance Ensure all programs and clinical operations are in full compliance with state and federal regulations, including HIPAA Ensure compliance with emergency management policies, procedures, and processes by serving as a liaison with other business units Monitor the effectiveness of existing procedures and outreach/intervention efforts in demonstrating positive outcomes for patients Ensure appropriate care planning, education, and interventions are conducted for members identified as at risk Ensure staff coordinate the exchange of information between behavioral health and medical providers in developing comprehensive care plans for at-risk members Monitor data to address quality measures, trends, and improvement opportunities, including provider issues, service gaps, and patient needs Evaluate the effectiveness of care management programs and implement adjustments when opportunities for improvement are identified