Care Manager, RN (Work From Home)

NeueHealth; Los Angeles (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare company is seeking a Care Manager, RN to provide patient-centered care from home. The role involves assessing needs, developing care plans, and coordinating with healthcare teams to ensure quality outcomes. Candidates should have an active RN license in California and experience in medical management.

Benefits

Health insurance

Life insurance

Disability insurance

401(k)

PTO

Holidays

Qualifications

• Active RN license in California required.
• At least 2 years of experience in medical management.
• Case Management (CCM) or Managed Care Nursing (CMCN) certification preferred.

Responsibilities

• Assess medical, social, and behavioral needs of assigned population.
• Develop and prioritize care plans to promote health.
• Coordinate interdisciplinary team meetings.

Skills

Critical thinking

Problem-solving

Effective communication

Time management

Flexibility

Education

Associate's degree in Nursing

Bachelor's degree in Nursing (preferred)

Tools

MCG standards

InterQual standards

NCQA standards

Job description

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We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.

We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

SCOPE OF ROLE

The Care Manager promotes quality, cost-effective outcomes by facilitating collaboration across settings, assessing needs, planning care, monitoring interventions, and advocating for members to receive necessary services and resources. The role involves providing patient-centered care across the continuum.

ROLE RESPONSIBILITIES

• Assess medical, social, and behavioral needs of assigned population
• Develop and prioritize care plans to promote health and self-management
• Coordinate interdisciplinary team meetings
• Collaborate with providers and settings to ensure quality outcomes
• Implement transition of care interventions
• Facilitate care coordination, discharge planning, and health education
• Link members to community resources addressing social determinants of health
• Review referrals and apply clinical criteria to coordinate care
• Ensure member communication complies with regulatory standards
• Follow policies set by the Quality Management Committee

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Associate's degree in Nursing; Bachelor's preferred
• At least 2 years of experience in medical management
• Knowledge of MCG, InterQual, and NCQA standards

LICENSURES AND CERTIFICATIONS

• Active RN license in California
• Case Management (CCM) or Managed Care Nursing (CMCN) certification preferred

PROFESSIONAL COMPETENCIES

• Critical thinking and problem-solving skills
• Strong work ethic and positive attitude
• Effective verbal and written communication
• Time management and ability to work independently
• Flexibility, organization, self-motivation
• Adaptability to change

Compensation range in California: $29.92-$44.87/hour. Benefits include health, life, disability insurance, 401(k), PTO, and holidays.

We are an Equal Opportunity Employer, committed to diversity and inclusion. All qualified applicants will be considered without regard to protected characteristics.