Care Manager, RN – Health Access, ECM

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

📋 Description

• Oversee a caseload of members with medical needs by utilizing independent clinical judgment and strategic planning.

• Suggest care coordination strategies through clinical tools and metrics, manage caseloads, and appropriately escalate high-risk cases.

• Interact with members both in person and via phone by employing evidence-based techniques such as Motivational Interviewing.

• Perform comprehensive, holistic assessments within the RN scope of practice.

• Create personalized care plans and communicate them with members, caregivers, and care team members.

• Facilitate interdisciplinary care team meetings and update care plans accordingly.

• Collaborate with internal and external health partners to address members’ comprehensive care needs.

• Engage in and lead care transition planning initiatives.

• Address medical and behavioral health access challenges with primary care offices, specialists, and ancillary services.

• Coordinate care for members with intricate medical and social requirements across physical, behavioral, and dental health systems.

• Provide training, clinical consultation, and support to Health Access team members.

• Act as the lead representative for the Enhanced Care Management team when necessary.

• Develop interventions aimed at enhancing members’ capacity to manage their health.

• Assist non-clinically licensed care team members within the RN scope of practice.

• Establish partnerships with providers, team members, and community stakeholders through in-person, telephonic, and digital platforms.

• Foster effective collaboration and resolve conflicts within the care management team.

• Engage in quality improvement initiatives, including addressing HEDIS gaps and other performance measures.

• Attend staff, training, and committee meetings as required.

• Ensure precise documentation adheres to regulatory and accreditation standards.

• Carry out additional duties necessary to support Health Plan operations and departmental business needs.

⛳️ Requirements

• Minimum of three (3) years of care management experience in a healthcare delivery environment is required.

• Proven experience working effectively within a team is essential.

• Demonstrated ability to develop and maintain strong relationships with clients and colleagues is required.

• Experience in a Managed Care setting is preferred.

• At least one (1) year of clinical experience in an acute care facility, skilled nursing facility, home health, or clinic setting is preferred.

• An Associate’s degree in Nursing from an accredited institution is required.

• A Bachelor’s degree in Nursing from an accredited institution is preferred.

• Must possess an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN.

• Certified Case Manager (CCM) designation is preferred.

• A valid California Driver’s license and valid automobile insurance are required.

• Must meet and maintain a driving record to operate company vehicles based on IEHP insurance standards of no more than three (3) points.

• Strong understanding of evidence-based communication methods, such as Motivational Interviewing or similar empathy-based strategies.

• Awareness and sensitivity to multicultural communities are essential.

• Knowledge of self-management philosophies and practices, particularly as they relate to chronic medical conditions.

• Recognize the impact of unmitigated bias and judgment on health, with a commitment to addressing these issues.

• Bilingual (English/“Target Language”) proficiency is preferred.

• Exceptional interpersonal and relationship-building skills are required.

• Highly developed interpersonal communication skills, including the ability to resolve conflicts with colleagues.

• Capability to share expertise both informally and formally.

• Ability to manage, tolerate, and effectively navigate high levels of ambiguity surrounding new team models, innovative care approaches, and contemporary care management practices.

• Must reside within a 25-mile radius of the assigned service area and possess reliable transportation.

🏝️ Benefits

• Competitive salary.

• Access to a state-of-the-art fitness center on-site.

• Medical insurance that includes dental and vision coverage.

• Options for life, short-term, and long-term disability insurance.

• Opportunities for career advancement and professional development.

• Wellness programs that encourage a healthy work-life balance.

• Flexible Spending Account for Health Care/Childcare.

• CalPERS retirement plan.

• 457(b) option with a contribution match.

• Paid life insurance for employees.

• Pet care insurance.

• Option for telecommuting work locations.

• While paid travel or transportation support is not explicitly mentioned, reliable transportation is required.