Registered Nurse Case Manager

Medix; San Jose (CA); Vor Ort; USD 116.000 - 144.000; Vollzeit

Zusammenfassung

Medix is seeking an experienced Registered Nurse Case Manager in San Jose, California. The role focuses on coordinating medical and psychosocial care to help members achieve health goals and maintain independence.

You will collaborate with families, providers, and community services to develop personalized care plans, support positive outcomes, and navigate the healthcare system with a member-centered approach.

Qualifikationen

• 3+ years in case management, discharge planning, patient education, or related field.
• Knowledge of managed care principles and case management/utilization management.
• Strong clinical knowledge and ability to assess whole-person healthcare needs.
• Ability to develop individualized care plans addressing medical, psychosocial, and functional needs.
• Proficiency with MS Outlook, Word, Excel and case management software.

Aufgaben

• Maintain accurate, organized case files in accordance with policies and regulations.
• Develop individualized care plans with patient- and family-focused goals.
• Coordinate care among primary care providers, specialists, behavioral health professionals, and LTSS providers.
• Help members access medical, behavioral health, and social services to maintain independence.
• Facilitate transitions between care settings and coordinate appointments, medications, and follow-up.

Kenntnisse

Clinical knowledge

Critical thinking

Care coordination

Communication

MS Office

Case management software

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Case management software

Jobbeschreibung

Registered Nurse Case Manager (258950) San Jose, California

Salary: USD56 - USD69 per hour

Registered Nurse (RN) Case Manager

Job Overview

We are seeking an experienced Registered Nurse (RN) Case Manager to join a highly rated California health plan in San Jose. In this role, you will serve as a member advocate, coordinating medical and psychosocial care to help members achieve their individualized health goals and maintain the highest possible level of independence.

The RN Case Manager will collaborate with members, families, primary care providers, specialists, behavioral health professionals, and community service providers to develop personalized care plans, coordinate services, and support positive, cost-effective health outcomes.

Key Responsibilities

Maintain accurate, organized, and compliant case files in accordance with organizational policies, state and federal regulations, and audit requirements.

Collaborate with members and their families or responsible parties to develop and implement individualized care plans with prioritized, member-specific goals.

Coordinate care among primary care providers, specialists, behavioral health professionals, and Long-Term Services and Supports (LTSS) providers.

Help members access necessary medical, behavioral health, and social services to maintain or improve their functional independence and remain safely in their homes or communities.

Facilitate transitions between care settings by coordinating medical appointments, pharmacy assistance, follow-up services, and utilization review as appropriate.

Support transitions from nursing facilities to lower levels of care or community-based settings in collaboration with applicable providers and programs, when assigned to MLTSS.

Conduct telephonic assessments to evaluate member needs, identify barriers to care, and support the development of appropriate care plans.

Advocate for members by connecting them with available healthcare benefits, community resources, and support services.

Required Qualifications

Minimum of 3 years of experience in case management, discharge planning, patient education, or an equivalent combination of relevant experience, education, or certifications.

Knowledge of managed care principles and practices, particularly case management and/or utilization management.

Strong clinical knowledge, critical-thinking skills, and the ability to assess whole-person healthcare needs.

Ability to develop individualized care plans that address medical, psychosocial, and functional needs.

Proficiency with Microsoft Outlook, Word, Excel, and the ability to navigate case management software and other computer applications.

Strong communication, organization, care coordination, and problem-solving skills.

Preferred Qualifications

Bilingual proficiency in Spanish, Vietnamese, Chinese, or Tagalog.

Experience working with specific member populations, including behavioral health populations, seniors, individuals with disabilities, or children.

Why Consider This Opportunity?

Opportunity to work with a highly rated California health plan.

Competitive pay.

Meaningful work advocating for members and helping them navigate the healthcare system.

Collaborative, multidisciplinary care environment.

Consistent weekday schedule, Monday through Friday.