Nurse Case Manager

• Perform care management within the scope of licensure for members with complex and chronic care needs
• Assess, develop, implement, coordinate, monitor, and evaluate care plans across the care continuum
• Ensure member access to services appropriate to health needs
• Conduct assessments to identify individual needs and care management objectives and goals
• Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate care plan effectiveness and modify plans as necessary
• Interface with Medical Directors and Physician Advisors on care management treatment plans
• Assist with problem solving involving providers, claims, or service issues
• Perform duties telephonically with medical groups, providers, community resources, and members for discharge planning

• BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
• Current, unrestricted RN license in the state of California required
• Case Manager experience within hospital or managed care setting is preferred
• Clinical experience working with individuals with various chronic diseases, illnesses and medical needs strongly preferred
• Knowledge/experience with discharge planning preferred
• Work 8-hour shifts between 7:30am and 6pm Pacific Time
• Candidates must reside within a reasonable commuting distance from the posting locations unless an accommodation is granted as required by law
• New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided

Demonstrates expertise in care management for individuals with complex and chronic care needs, including assessment, care plan development, and coordination of services. Holds a current RN license in California and possesses significant clinical experience in managed care settings.

• RN License in California
• Care Management
• Clinical Experience with Chronic Diseases
• Discharge Planning
• Case Management Experience

• Care Plan Development
• Assessment and Evaluation
• Coordination of Services
• Monitoring Care Plan Effectiveness
• Facilitating Authorizations and Referrals

• Problem Solving
• Communication

• Managed Care
• Chronic Care Management
• Health Needs Assessment
• Telephonic Care Management
• Patient Discharge Planning