RN Nurse Case Manager II, California HMO

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

📋 Description

• Provide care management services within the boundaries of licensure for members requiring complex and chronic care.

• Evaluate, design, execute, coordinate, supervise, and assess care plans throughout the care continuum.

• Conduct telephonic communications with medical groups, healthcare providers, community resources, and members for discharge planning purposes.

• Guarantee member access to services that align with their healthcare requirements.

• Carry out assessments to pinpoint individual needs and create tailored care management plans.

• Facilitate authorizations and referrals within the benefits framework or through additional contractual arrangements.

• Organize both internal and external resources to fulfill identified needs.

• Monitor and assess the effectiveness of care plans, making adjustments as necessary.

• Collaborate with Medical Directors and Physician Advisors regarding care management treatment strategies.

• Support problem-solving efforts related to providers, claims, or service challenges.

• Contribute to the formulation of utilization and care management policies and procedures.

⛳️ Requirements

• Bachelor's degree in a health-related discipline and a minimum of 5 years of clinical experience; or any combination of education and experience that provides a comparable background.

• A valid, unrestricted RN license in the state of California is required.

• Experience as a Case Manager in a hospital or managed care environment is preferred.

• Strong clinical background working with individuals who have diverse chronic diseases, illnesses, and medical needs is highly preferred.

• Familiarity or experience with discharge planning is preferred.

• Certification as a Case Manager is preferred.

• Availability to work an 8-hour shift between 8 AM and 6 PM Pacific Time.

• Candidates should reside within a reasonable commuting distance from the job locations unless an accommodation is legally required.

• New candidates in certain patient/member-facing positions must receive vaccinations against COVID-19 and Influenza, unless they provide an acceptable justification.

🏝️ Benefits

• Comprehensive benefits package.

• Incentive and recognition programs.

• Equity stock purchase options.

• 401(k) contributions.

• Merit-based salary increases.

• Paid holidays.

• Paid Time Off.

• Incentive bonus programs.

• Medical insurance benefits.

• Dental insurance benefits.

• Vision insurance benefits.

• Short-term disability insurance.

• Long-term disability insurance.

• 401(k) with matching contributions.

• Stock purchase plan.

• Life insurance.

• Wellness program offerings.

• Financial education resources.

• Overtime compensation for associates working from California, in accordance with California employment regulations.