Remote Ambulatory Case Manager (RN)

PriMed Management Consulting Services, Inc.; Sacramento (CA); Hybrid; USD 90,000 - 123,000; Full time

Job summary

Hill Physicians Medical Group in California seeks a seasoned RN Case Manager to provide telephonic and digital case management for health plan members, focusing on transitions after emergency department visits or hospitalizations to prevent readmissions.

The role requires 5+ years of clinical nursing and 2+ years in case management within managed care, plus proficiency with telephonic platforms, electronic charting, and diverse health-system navigation. Remote work is supported.

Qualifications

• Associate degree in nursing with California RN licensure.
• Minimum 5 years of clinical nursing experience.
• At least 2 years in case management within managed care.
• Knowledge of ICD-10 and CPT coding.

Responsibilities

• Provide telephonic and digital case management to health plan members.
• Assess, plan, implement, coordinate, monitor and evaluate care.
• Coordinate care across primary care, specialty care, behavioral health, and pharmacy.
• Ensure timely follow-up after ED visits or hospital discharges.
• Maintain documentation in the case management system.
• Promote medication adherence and self-management.

Skills

Nursing

Case Management

ICD-10 coding

CPT coding

Managed Care

Education

Associate degree in Nursing (A.S.)

Tools

Outlook

Teams

Electronic Health Records

Job description

Hill Physicians Medical Group in California seeks a seasoned RN Case Manager to provide telephonic and digital case management for health plan members, focusing on transitions after emergency department visits or hospitalizations to prevent readmissions.

The role requires 5+ years of clinical nursing and 2+ years in case management within managed care, plus proficiency with telephonic platforms, electronic charting, and diverse health-system navigation. Remote work is supported.