Case Manager, RN - CA

Acentra Health, LLC; California; Remote; USD 67,000 - 93,000; Full time

Job summary

Acentra Health is seeking a Nurse Case Manager to join our remote team supporting beneficiaries in California. You will evaluate needs, develop care plans, and coordinate with the healthcare team to meet payer requirements and CMSA-based care management standards.

Remote role requiring CA residency (Los Angeles or San Diego preferred). You will manage a caseload, document assessments, and pursue ongoing education to stay current with regulatory changes while maintaining strict confidentiality

Qualifications

• Bachelor’s degree or BSN required.
• Active, unrestricted CA RN license.
• At least 3 years of clinical experience.
• At least 1 year in case management review.
• Residency in CA required.
• Strong communication and customer service.
• Ability to work independently and as part of a team.
• Maintain confidentiality and comply with HIPAA.

Responsibilities

• Assess, plan, and coordinate care to meet beneficiary needs.
• Collaborate with providers to develop beneficiary-centered care plans.
• Document assessments and care activities in the web-based system.
• Ensure compliance with payer requirements and CMSA principles.
• Maintain confidentiality and uphold HIPAA standards.
• Manage caseload to meet regulatory timelines and goals.

Skills

Communication skills

Independent worker

Confidentiality

Team coordination

Multitasking

RN license CA

Education

Bachelor’s degree/BSN

Job description

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

At Acentra Health, we embrace emerging technologies, including artificial intelligence and advanced analytics that can be utilized to improve processes, enhance decision-making, and drive better health outcomes. We value professionals who are curious about new technologies and motivated to use innovative tools to increase efficiency, quality, and impact in their roles.

Job Summary and Responsibilities

Acentra Health is looking for a Nurse Case Manager to join our growing team now!

Job Summary:

The Nurse Case Manager will evaluate beneficiaries' needs, develop individualized care plans, and coordinates healthcare team members to ensure optimal client outcomes while adhering to payer requirements. They also facilitate integrated case and disease management activities based on CMSA principles, aiming to stabilize beneficiaries' health and avoid long-term care placement.

Position is remote, but candidates must reside in California, preferably in Los Angeles or San Diego area.

Responsibilities:

• Assess, plan, implement, monitor, and evaluate options and services to affect an appropriate,individualized plan with the beneficiary across the continuum of care.
• Utilize clinical knowledge and competence, communication skills, problem-solving, andconflict resolution to ensure optimal beneficiary outcomes with consideration to clientrequirements effectively.
• Develop beneficiary-centered care plans.
• Demonstrate shared accountability between beneficiaries, caregivers, and providers.
• Work collaboratively with the beneficiary, provider, and other Health Care teammembers to coordinate care.
• Address identified gaps in care or compliance.
• Maintain strict standards for client confidentiality and client-related information.
• Comply with all organizational, state, and federal regulations and policies on confidentiality.
• Manage caseload to ensure all required documentation and entry of assessment results intothe web-based database are completed accurately and timely, following regulatoryrequirements and company policies and procedures.
• Maintain open communication with all appropriate parties.
• Pursue ongoing education, certification, and self-development to remain current with casemanagement standards.
• Read, understand, and adhere to all corporate policies including policies related to HIPAAand its Privacy and Security Rules
• This position primarily involves working at a desk and using a computer for extended periods of time
• Other duties as assigned

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

Required Qualifications

• Bachelor’s degree/BSN.
• Active, unrestricted RN (Register Nurse) license in CA
• A minimum of 3+ yearsof clinical experience.
• A minimum of 1+ years of case management review experience.
• Must reside in the state of CA
• Successful communication (written/verbal), with a strong focus on customer service, including building andmaintaining relationships with internal/external customers.
• Ability to work independently and as part of a team.
• Maintain a high level of confidentiality.
• Ability to maintain metrics and goals within the department.

Preferred Qualifications

• Bilingual in Spanish
• Ability to assist members and conduct outreach to members without prior engagement.
• Strong cultural competency and the ability to work effectively with diverse populations.
• Flexibility and strong organizational skills.
• Ability to multi-task and prioritize with variable and sometimes conflicting deadlines; superior attention to detail and demonstrated ability in decision-making.

• Maintain professionalism, flexibility, and dependability under pressure.
• Ability to research/identify and apply appropriate standards of care.
• Interest in continuous learning and a commitment to staying informed on regulatory changes.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

We are committed to providing a secure and positive hiring experience. Depending on the role, interviews may be conducted virtually, in person, or through a combination of both. As part of our recruitment process, candidates may be asked to participate in identity verification measures to help ensure the integrity of the hiring process.

~ The Acentra Health Talent Acquisition Team

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay range for this position is listed below.

“Based on our compensation philosophy, an applicant’s position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level.”

Pay Range

USD $67,300.00 - USD $93,050.00 /Yr.