Bilingual RN Case Manager, SNP – California RN License

This is a fully remote position, open to applicants in California.

📋 Description

• Oversee and organize healthcare services for members with intricate and chronic care requirements within the boundaries of licensure.

• Provide care utilizing the nursing process.

• Engage with members, caregivers, and participants from the interdisciplinary team.

• Assist in closing care gaps and overcoming obstacles to enhance health.

• Initiate contact and connect with members via telephone.

• Serve as a resource for members, families, and physicians in coordinating care.

• Ensure timely access to necessary care for urgent or immediate situations.

• Manage referrals and authorizations within the framework of benefits.

• Conduct thorough evaluations of health status, resource usage, treatment plans, and services.

• Collaborate with members, primary care providers (PCPs), and care teams to execute care plans.

• Liaise with physicians, hospitalists, nurse practitioners, and specialists on care management treatment strategies.

• Offer education and support for self-management.

• Assist healthcare providers with claims or service-related issues.

• Coordinate with delegated or contracted providers, groups, and entities.

• Uphold the confidentiality of protected health information in accordance with legal and company policies.

⛳️ Requirements

• At least 2 years of clinical experience.

• A minimum of 1 year in case management.

• Successful completion of post-high-school courses leading to RN licensure or an Associate's degree in Nursing.

• Must possess and maintain a valid, active, and unrestricted RN license in California (Non-Compact).

• Willingness to obtain LVN and/or RN licensure in Nevada (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) immediately upon hiring.

• In-depth understanding of community resources, treatment alternatives, home health care, funding sources, and special programs.

• Comprehensive knowledge of chronic condition management.

• Strong written and verbal communication skills.

• Capability to build and sustain constructive relationships with diverse members, management, employees, and vendors.

• Ability to communicate positively, professionally, and effectively; to provide leadership, teach, and collaborate.

• Proficient in PC-based software applications, including Word, Excel, and PowerPoint.

• Competent in performing mathematical calculations and basic statistics.

• Skill in prioritizing multiple tasks while employing advanced problem-solving and reasoning abilities.

• Effective problem-solving, organizational, and time management skills; able to thrive in a fast-paced environment.

• Ability to understand and analyze statistical reports.

🏝️ Benefits

• LVN and/or RN licensure in Nevada, Arizona, North Carolina, and Texas will be reimbursed by the company.

• Equal Opportunity/Affirmative Action Employer.