Lead RN Care Manager – Managed Care & Care Coordination

Community Health Plan of Imperial Valley; Oregon; Hybrid; USD 85,000 - 125,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

Paid time off

401k plan with generous match

Chance to make a real difference in a等

Job summary

Community Health Plan of Imperial Valley (CHPIV) seeks an experienced RN leader to guide the care coordination team and ensure regulatory alignment.

You will manage caseloads, maintain electronic case management records in HIPAA-compliant systems, and promote collaboration with providers, family, and caregivers to improve continuity of care.

Remote or onsite options within California are considered; a competitive salary $85,000-$125,000 per year plus benefits.

Qualifications

• Active California RN license without restriction.
• Minimum 3+ years leading care coordinators.
• 3+ years in management, case management, or managed care in medical or behavioral health settings.
• Knowledge of managed care principles with emphasis on care management.
• Clinical knowledge to assess whole-person care needs for effective plans.
• Proficient in Outlook, Word, Excel and case management software.

Responsibilities

• Provide direction and guidance to the care coordination team to ensure implementation of activities that align with the model of care and meet regulatory requirements.
• Manage caseloads for the team appropriately with regard to complexity of medical or psychosocial needs.
• Maintain electronic case management documentation system in compliance with standard processes and HIPAA.
• Complete all training requirements and implement changes.
• Promote multidisciplinary collaboration, provider outreach, and engagement of family and caregivers to enhance continuity of care for members.
• Audit case management assessments and care plan development for completeness and timeliness according to state requirements.
• Monitor the completeness of the TOC assessment and timeframes for contact per TOC protocols.
• Participate in required internal and external audits both remote or onsite.
• Create business requirement documents, user training materials and other related documentation.
• Assist with care coordination for appropriate resources and services for members.

Skills

Care coordination leadership

Management experience

Clinical knowledge

Outlook/Word/Excel proficiency

Collaboration with healthcare teams

Education

California Registered Nurse License

Tools

Outlook

Word

Excel

Case management software

Job description

Community Health Plan of Imperial Valley (CHPIV) seeks an experienced RN leader to guide the care coordination team and ensure regulatory alignment.

You will manage caseloads, maintain electronic case management records in HIPAA-compliant systems, and promote collaboration with providers, family, and caregivers to improve continuity of care.

Remote or onsite options within California are considered; a competitive salary $85,000-$125,000 per year plus benefits.