RN Case Manager

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

📋 Description

• Act as the RN of record for around 500 Enhanced Care Management members.

• Provide clinical oversight and review documentation for care plans, assessments, and progress notes.

• Address clinical escalations and ensure adherence to legal and payer regulations.

• Offer clinical approval on personalized whole-person care plans.

• Collaborate with primary care providers, specialists, hospitals, behavioral health professionals, and community organizations.

• Track member progress and outcomes, modify care plans, and ensure follow-up through remote documentation reviews and telehealth processes.

• Facilitate transitions in care, planning for discharges, follow-up appointments, and coordination for home-based care.

• Advocate for prompt access to treatments, medications, and support services.

• Analyze utilization patterns and develop strategies to minimize unnecessary hospital and emergency department visits.

• Review payer and quality performance reports to pinpoint care gaps and execute improvement initiatives.

• Mentor team members on quality enhancement, safety, and best practices in case management.

• Ensure compliance with Medi-Cal, HEDIS, and quality standards while promoting health equity.

• Perform additional responsibilities as needed.

⛳️ Requirements

• Active California RN license in good standing, required regardless of the RN's location.

• At least 2 years of experience as a Registered Nurse.

• Strong knowledge of Medi-Cal, care coordination, and social determinants of health.

• Exceptional analytical, clinical judgment, interpersonal, and communication abilities.

• Proficient in MS Office (Excel, Word, Outlook) and electronic health record systems.

• Capability to work from 8:30 a.m. to 5:00 p.m. PST, irrespective of home time zone.

• Reliable high-speed internet and a private, HIPAA-compliant home office.

• Compassionate, nonjudgmental, and culturally aware approach.

• Successful completion of pre-employment drug screening and background check required.

• Willingness to work occasional evenings or weekends within a 40-hour workweek.

• Bachelor's or Associate degree in Nursing, with RN license preferred.

• Bilingual skills in Spanish preferred.

• Certified Case Manager (CCM) or equivalent certification preferred.

• Experience in Managed Care, Community Health, or Behavioral Health preferred.

• Certification or experience in Motivational Interviewing or empathy-based communication preferred.

🏝️ Benefits

• Medical, Dental, & Vision Benefits available after 60 days of employment.

• Short & Long-Term Disability Benefits.

• Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans.

• Flexible Spending Accounts.

• Employee Assistance Program (EAP).

• 401(K), effective after 1 year of employment.

• Paid Vacation and Sick Leave.

• Paid Holidays.

• Employee Referral Program.

• Company Discount Program.