Care Manager I, RN

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

📋 Description

• Develop and implement thorough, client-focused Individual Care Plans that align with program guidelines and policies.

• Identify, organize, and oversee suitable community services using expertise in Medicare, Medicaid, and other entitlement programs.

• Coordinate and facilitate patient care through assessment, evaluation, planning, and execution.

• Communicate patient needs to members of the care team and ensure appropriate follow-up.

• Manage discharge plans upon the conclusion of treatment.

• Collaborate with patients, families, physicians, and nurses to guarantee high-quality care.

• Advocate for patients concerning insurance coverage and financial assistance options.

• Maintain detailed clinical records through comprehensive documentation.

• Coordinate interdisciplinary care to ensure timely access, continuity among providers, and effective resource utilization.

• Apply principles of care transition, guide members through the continuum of care, and coordinate effective hand-offs to appropriate providers or health plans.

• Assist the UM Manager and participate in both internal and external audits.

• Act as the primary liaison with contracted health plans for case management activities.

• Ensure the privacy and security of PHI in compliance with HIPAA and organizational policies.

• Carry out additional duties and special projects as assigned.

⛳️ Requirements

• Registered Nurse, Licensed Vocational Nurse, or Medical Assistant certification is required.

• A minimum of two years of experience in utilization management is essential.

• Proficiency in applying evidence-based clinical criteria and benefit plans is required.

• At least three years of clinical experience, preferably in case management or a related field, is necessary.

• A Bachelor's degree in nursing or a related health services area is preferred.

• Certification in Case Management (CCM) is an advantage.

• Fluency in Tagalog or Ilocano is a beneficial asset.

• Familiarity with Medicare, Medicaid, and other entitlement programs is necessary.

• Understanding of HIPAA and requirements for protected health information is essential.

🏝️ Benefits

• Remote position available.

• Total compensation target pay range of $78,000–$91,000 annually.

• Equal Employment Opportunity and Affirmative Action employer.

• Reasonable accommodations offered for applicants with disabilities.