Case Manager; RN/LIC Job Riverside area,California USA,Nursing

Position: Case Manager (RN/LIC)

Responsibilities

Come and join the RMC Family!

We have been in the community since 1935. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward.

We are working to change lives and transform the delivery of healthcare.

Riverside Medical Clinic is the best place to work, practice medicine, and receive care.

Summary

Under the general direction of the Director of Utilization Management, the Population Health RN Case Manager will coordinate team‑based care to provide health services to individuals, through effective partnerships with patients, their caregivers/families, community resources, and their physician. This role focuses on improving the health status and care for individuals with chronic conditions; potentially complex medical, mental health, and psychosocial issues;

and implementing the utilization review, clinical review plan approvals, discharge planning, and transitional case management processes. Duties will be performed in accordance with NCQA, federal, state, and local guidelines, organizational and departmental policies and procedures. Communicates with medical staff, other departments, and outside agencies while maintaining confidentiality.

Hours

Monday‑Friday 8:00 AM – 5:00 PM

Qualifications

Education and/or

Experience:

Current licensure as a Registered Nurse required. Two or more years’ experience in clinical or community health settings preferred. Previous Care Coordination, Case Management or Home Health experience preferred. Previous experience with mobilizing community resources, navigating patients through the healthcare continuum, and working with disparate populations preferred. Must possess strong clinical assessment and critical thinking skills necessary to develop a comprehensive plan of care appropriate to patients with complex medical, emotional and social needs.

Has the ability to work in a high‑volume caseload environment and deal effectively with rapidly changing priorities. Experience with mobilizing community resources, navigating patients through the healthcare continuum, and working with disparate populations preferred.

Certificates, Licenses, AND Registrations: Current, active, non‑restricted California Registered Nursing License. CCM Certification preferred.

Essential Functions

Provide a coordinated, strategic approach to identify new or manage an established chronically ill patient population.

Stratify patient population according to risk to effectively and efficiently manage patients. Determine frequency of need for provider appointment and CCM encounters. Maximize use of qualified clinical staff within the care management team to provide appropriate non‑face‑to‑face patient contact.

Collaborate with practice leaders to implement effective internal tracking systems for patients such as patient panels, annual wellness visit scheduling, and transition of care follow‑up calls/timely provider visits, and CCM non‑face‑to‑face monthly encounters.

Ensure all required elements are documented for CCM and related Annual Wellness Visits (AWV) component billing.

Collaborate with practice leaders to establish a method for assigning patients into a panel listing by provider that is routinely utilized for scheduling purposes and is continually monitored to balance supply and demand. Utilize empanelment method to ensure that preventive, chronic, and acute needs of all patients are met, including both high and low utilizers.

Ensure office staff has an effective internal tracking process to capture results, medication acquisition, missed appointments, and adherence to follow‑up appointments.

Develop a process to track Annual Wellness Visits (AWV) scheduling and ensure that patient records are reviewed appropriate to identify care gaps prior to visit with the provider visit. Post reminders to secure that all co‑morbidities are discussed and documented during AWV.

Participate in routine…

Case Manager; RN​/LIC

Case Manager; RN/LIC