Remote RN Case Manager, CalAIM Authorization & Care

CalOptima Health Partnership; Orange (CA); Remote; USD 91,000 - 145,000; Full time

Benefits offered by this job

Full Telework

Comprehensive benefits package

CalPERS pension

Generous PTO

Flexible scheduling

Job summary

CalOptima Health is seeking an RN Medical Case Manager for CalAIM, supporting authorization and referrals in a fully teleworking role within California. You will collaborate with providers, CalAIM teams, and community stakeholders to ensure appropriate medical review and efficient care coordination.

Required RN licensure in California with ADN plus 3 years of nursing experience; 1 year in clinical review. BSN preferred, bilingual abilities beneficial for service delivery and member outreach.

Qualifications

• ADN in nursing plus 3 years of nursing experience with 1 year as Clinical Nurse Reviewer.
• Current unrestricted RN license to practice in California.
• BSN preferred.
• Bilingual in English and a threshold language (optional).

Responsibilities

• Review and process authorization and notification of CalAIM services.
• Authorize referral requests using CalOptima Health criteria.
• Interact with provider callers and serve as a resource.
• Coordinate member care with health networks and CalAIM providers.
• Meet productivity and quality standards.
• Complete other duties as assigned.

Skills

Nursing skill

Communication

Independent work

Education

ADN in nursing

BSN (preferred)

Tools

Microsoft Office

Job description

CalOptima Health is seeking an RN Medical Case Manager for CalAIM, supporting authorization and referrals in a fully teleworking role within California. You will collaborate with providers, CalAIM teams, and community stakeholders to ensure appropriate medical review and efficient care coordination.

Required RN licensure in California with ADN plus 3 years of nursing experience; 1 year in clinical review. BSN preferred, bilingual abilities beneficial for service delivery and member outreach.