Bilingual Spanish RN Case Manager | Medicare Special Needs Program (SNP) |Remote | Active California RN License Required (Non-Compact)

Alignment Health; California; Remote; USD 90,000 - 120,000; Full time

Job summary

Alignment Health seeks a Remote RN Case Manager SNP licensed in California to manage care for chronically ill and frail members living in the community. The role involves coordinating care, contacting members by phone, and guiding referrals within the benefit structure.

The position requires RN licensure in California, with potential for growth and cross-state licensure expansion. Strong communication and data-management skills are essential to support high-quality, person-centered care.

Qualifications

• RN licensure in California is required.
• Post high school coursework to obtain RN licensure.
• BSN is preferred but not required.

Responsibilities

• Delivers care to members using the nursing process with the care team.
• Close gaps in care and resolve barriers to improve health.
• Reach out to members by telephone and coordinate care.
• Serve as a resource for member, family, and physician.
• Facilitate referrals and authorizations within benefits.
• Maintain PHI confidentiality per law and policy.

Skills

Case management

Care coordination

Communication

PHI confidentiality

Education

RN licensure (California)

AS in Nursing

BSN (preferred)

Tools

Word

Excel

PowerPoint

Job description

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them.

The Remote RN Case Manager SNP (must have RN License in California [Non-Compact]) is responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs.

Key Responsibilities

• Delivers care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants.
• Assist with closing gaps in care and resolving barriers that prevent members from attaining improved health.
• Reaches out and connects with members via the telephone.
• Coordinates care by serving as a resource for the member, their family, and their physician.
• Ensures access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.
• Completes comprehensive assessments within their scope of practice that includes assessing the member's current health status, resource utilization, past and present treatment plan, and services.
• Collaborates with the member, the PCP, and other members of the care team to implement a plan of care.
• Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on the development of care management treatment plans.
• Provides education and self-management support based on the member's unique learning style.
• Assists in problem solving with providers, claims or service issues.
• Works closely with delegated or contracted providers, groups, or entities to assure effective and efficient care coordination.
• Maintains confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy.

Key Qualifications

• Minimum 1 year case management experience.
• Health Plan experience preferred
• Successfully passing Post High School courses to obtain an RN licensure or AS in Nursing.
• Preferred: BSN or Bachelor's
• Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
• Extensive knowledge of the management of chronic conditions
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPoint
• Ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Must have and maintain an active, valid, and unrestricted RN license in California (Non-Compact)
• Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.