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

Alignment Health; United States; Remote; USD 78,000 - 117,000; Full time

Job summary

Alignment Health is seeking a Remote RN Case Manager SNP to coordinate care for members with complex and chronic needs, leveraging the nursing process and collaboration with physicians and care teams. California RN licensure (Non-Compact) is required, with potential licensure expansion to additional states after hire.

The role emphasizes closing gaps in care, education and self-management support, and effective communication by telephone with members and care partners, working 8:00am–5:00pm

Qualifications

• Minimum 2 years clinical experience.
• Minimum 1 year case management experience.
• RN license in California (Non-Compact) required.

Responsibilities

• Coordinates care for members, families, and physicians.
• Facilitates referrals/authorizations within the benefit structure.
• Completes comprehensive assessments within scope of practice.
• Collaborates with PCP and care team to implement a plan of care.
• Interfaces with providers to develop management plans.
• Provides education and self-management support to members.
• Addresses issues with claims or services as needed.
• Maintains confidentiality of PHI per Alignment Health policy.

Skills

Care coordination

Chronic disease mgmt

Phone communication

Interdisciplinary teamwork

Nursing process

Education

RN licensure in CA

AS in Nursing

BSN preferred

Tools

MS 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. It takes an entire team of passionate and caring people, united in our mission to put the senior first. 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. Together.

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. 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.

Schedule: Must be willing to work 8:00am - 5:00pm Pacific Time

General Duties / Responsibilities

• 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.

Supervisory Responsibilities

N/A

Experience

Job Requirements

• Required:
• Minimum 2 years' clinical experience
• Minimum 1 year case management experience.
• Preferred: Health Plan experience preferred

Education

• Required: Successfully passing Post High School courses to obtain an RN licensure or AS in Nursing.
• Preferred: BSN or Bachelor's

Specialized Skills

• Required:
• 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 communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPoint
• Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Comprehend and analyze statistical reports.

Licensure

• Required:
• 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.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions

• While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
• The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $77,905.00 - $116,858.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

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.