Telephonic RN Case Manager, SNP – Bilingual Preferred

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

📋 Description

• Acts as a resource for members, their families, and their physicians to coordinate care effectively.

• Facilitates referrals and authorizations to ensure members with urgent or immediate needs have access to appropriate care within the benefit framework.

• Conducts thorough assessments within their professional scope, evaluating the member's current health status, resource utilization, and past and present treatment plans and services.

• Works collaboratively with the member, the Primary Care Physician (PCP), and other care team members to establish and implement a comprehensive care plan.

• Engages with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists to develop effective care management treatment strategies.

• Offers education and self-management support tailored to the member’s distinct learning preferences.

• Aids in resolving issues related to providers, claims, or services.

• Collaborates closely with delegated or contracted providers, groups, or entities to ensure efficient and effective care coordination.

• Upholds the confidentiality of all Protected Health Information (PHI) in accordance with state and federal regulations and Alignment Healthcare policies.

⛳️ Requirements

• At least 2 years of clinical experience.

• Minimum of 1 year of experience in case management.

• Successful completion of Post High School courses necessary to obtain RN licensure or an Associate's Degree in Nursing.

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

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Paid time off.