Bilingual Spanish RN Case Manager – Medicare Special Needs Program, Active California RN License Required

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

📋 Description

• Act as a resource for members, families, and physicians by coordinating care

• Facilitate referrals and authorizations to ensure access to appropriate care for urgent or immediate needs

• Conduct comprehensive assessments that cover health status, resource utilization, treatment plans, and services

• Collaborate with members, primary care physicians (PCPs), and care teams to implement care plans

• Work alongside Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on care-management treatment plans

• Provide education and self-management support tailored to the learning styles of members

• Assist with provider, claims, and service-related issues

• Collaborate with delegated or contracted providers, groups, and entities to ensure effective care coordination

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

• Reach out to and connect with members via telephone

• Deliver care utilizing the nursing process for members facing complex and chronic care needs

⛳️ Requirements

• A minimum of 2 years of clinical experience

• At least 1 year of case management experience

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

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

• Immediately upon hiring, must be willing to obtain LVN and/or RN licensure in Nevada (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact)

• Strong understanding of community resources, treatment options, home health, funding options, and special programs

• Comprehensive knowledge in the management of chronic conditions

• Excellent written and verbal communication skills

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

• Capable of performing mathematical calculations and basic statistical analysis

• Ability to prioritize multiple tasks and employ advanced reasoning to identify problems, gather data, establish facts, draw conclusions, and manage resolutions

• Strong problem-solving, organizational, and time-management abilities

• Proficient in comprehending and analyzing statistical reports

• Must be available to work from 8:00 am to 5:00 pm Pacific Time

🏝️ Benefits

• The company will reimburse for LVN and/or RN licensure in Nevada, Arizona, North Carolina, and Texas

• Equal Opportunity/Affirmative Action Employer