Senior Complex Case Manager (RN) - D-SNP

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration. That's why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer - and we genuinely appreciate your patience as we work through applications carefully and respectfully.

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties:
Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

There are 2 positions available as a Senior Complex Case Manager (RN) within the Care Management Department at the Alliance.

Reporting to the Medicare Care Management Manager (RN), this position:

• Develops and manages an individualized comprehensive plan of care for Medicare Dual Eligible Special Needs Plan (D-SNP) members referred into the Case Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner
• Works with and educates members, families, providers, external agencies, and internal departments on the D-SNP Case Management Program
• Participates in Quality Improvement studies, to continually evaluate the program's effectiveness and ability in promoting quality driven, cost effective, achievable goals and outcomes for members
• Performs D-SNP Program oversight and support activities
• Acts as a liaison between the D-SNP Program and providers and community agencies to promote effective implementation of program objectives and requirements

The Care Management Department's mission is to coordinate care and empower members to achieve their health and wellness goals through collaboration and by facilitating member relationships with community providers. We bring the voice of the member into the room when collaborating with our fellow departments at the Alliance.

• Knowledge of:
  • The principles and practices of clinical nursing
  • The principles and practices of case management, including motivational interviewing and evidence-based guidelines
  • Care management and coordination
  • Complex chronic conditions, geriatric care, and psychosocial factors impacting health outcomes
  • The principles and practices of developing and implementing health improvement strategies to address social determinants of health
  • Evidence-based practice guidelines in the development of care plans
  • Electronic health record and/or care management platforms
• Ability to:
  • Assess member risk, define problems, develop care plans, and collaborate across disciplines
  • Demonstrate strong critical thinking and problem-solving skills
  • Interpret and apply policies and regulations
  • Define issues, conduct research, interpret data, and identify and evaluate options
  • Evaluate medical records and other health care data
  • Organize work, manage complex priorities, and document with accuracy and timeliness
  • Communicate effectively with a diverse population of members, including those with behavioral health issues
• Education and Experience:
  • Current unrestricted license as a Registered Nurse issued by the State of California
  • Associate's degree in Nursing and a minimum of seven years of experience in a patient care setting, including a minimum of one year of case management experience (a Bachelor's degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
  • A minimum of one year of the required patient care experience must be in an acute or outpatient environment, working with adults and/or dual-eligible populations

• We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

• Zone 1 Pay Range: $125K - $140K Typical areas in Zone 1:
  Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
• Zone 2 Pay Range: $120K - $135K Typical areas in Zone 2:
  Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to…