Nurse Case Manager

Jobtailor; California (MO); On-site; USD 90,000 - 120,000; Full time

Job summary

Jobtailor seeks an experienced Care Manager with an active CA RN license to oversee care for patients with complex chronic needs. You will assess, develop, implement, coordinate, monitor, and evaluate care plans, and ensure access to services across the care continuum.

You will collaborate with Medical Directors, coordinate referrals, and support discharge planning while working 8-hour shifts PT. California residency preferred.

Qualifications

• RN license in California required.
• BA/BS in health-related field or equivalent background.
• Minimum 3 years of clinical experience.
• Experience with discharge planning is preferred.

Responsibilities

• Perform care management within licensure for members with complex and chronic needs.
• Assess, develop, implement, coordinate, monitor, and evaluate care plans.
• Ensure member access to services appropriate to health needs.
• Coordinate authorizations and referrals within benefits or through arrangements.
• Interface with Medical Directors and Physician Advisors on care plans.
• Telephonically perform duties with medical groups and members for discharge planning.

Skills

Care Management

RN License California

Discharge Planning

Assessment & Evaluation

Coordination of Services

Telephonic Care Management

Problem Solving

Communication

Education

RN license (California)

BA/BS in health-related field

Job description

• Perform care management within the scope of licensure for members with complex and chronic care needs
• Assess, develop, implement, coordinate, monitor, and evaluate care plans across the care continuum
• Ensure member access to services appropriate to health needs
• Conduct assessments to identify individual needs and care management objectives and goals
• Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements
• Coordinate internal and external resources to meet identified needs
• Monitor and evaluate care plan effectiveness and modify plans as necessary
• Interface with Medical Directors and Physician Advisors on care management treatment plans
• Assist with problem solving involving providers, claims, or service issues
• Perform duties telephonically with medical groups, providers, community resources, and members for discharge planning

Requirements

• BA/BS in a health related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
• Current, unrestricted RN license in the state of California required
• Case Manager experience within hospital or managed care setting is preferred
• Clinical experience working with individuals with various chronic diseases, illnesses and medical needs strongly preferred
• Knowledge/experience with discharge planning preferred
• Work 8-hour shifts between 7:30am and 6pm Pacific Time
• Candidates must reside within a reasonable commuting distance from the posting locations unless an accommodation is granted as required by law
• New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided

Core Competencies

Demonstrates expertise in care management for individuals with complex and chronic care needs, including assessment, care plan development, and coordination of services. Holds a current RN license in California and possesses significant clinical experience in managed care settings.

Highest-signal resume keywords

• RN License in California
• Care Management
• Clinical Experience with Chronic Diseases
• Discharge Planning
• Case Management Experience

Hard Skills

• Care Plan Development
• Assessment and Evaluation
• Coordination of Services
• Monitoring Care Plan Effectiveness
• Facilitating Authorizations and Referrals

Soft Skills

• Problem Solving
• Communication

Industry Keywords

• Managed Care
• Chronic Care Management
• Health Needs Assessment
• Telephonic Care Management
• Patient Discharge Planning