Remote RN Case Manager — Care Coordination Leader

Automatic Data Processing, Inc.; French Camp (CA); Remote; USD 103,000 - 145,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

PTO and holidays

Retirement plan

Job summary

Health Plan of San Joaquin (HPSJ) is seeking a Case Manager Nurse to join our team. This remote role requires you to reside in California and perform comprehensive case management to ensure appropriate care levels and compliance with regulatory requirements.

You will assess needs, develop care plans with members and PCPs, educate on services and coordinate with internal and external resources, while documenting and reporting outcomes. Experience with Medi-Cal/Medicare is a plus.

Qualifications

• RN license and graduation from an accredited nursing school.
• At least three years of clinical RN experience in hospital or clinic.
• At least three years performing case management, utilization management, or discharge planning.
• Experience with Medi-Cal and/or Medicare preferred.
• Maternal Health experience preferred.

Responsibilities

• Assess and evaluate members' care needs.
• Educate members on HPSJ services and case management.
• Develop complex care plans with member and PCP.
• Collaborate with member and family and resources to ensure adherence.
• Escalate high-risk issues to Medical Director for review.
• Monitor progress and intervene as needed.
• Document activities in HPSJ systems according to standards.
• Track data and prepare routine reports.
• Review care plans from LVN/entry-level case managers.

Skills

Clinical skills

Utilization management

Discharge planning

Case management

Communication skills

English proficiency

Time management

Data entry

Word and Excel

Education

RN license

Tools

Word

Excel

Job description

Health Plan of San Joaquin (HPSJ) is seeking a Case Manager Nurse to join our team. This remote role requires you to reside in California and perform comprehensive case management to ensure appropriate care levels and compliance with regulatory requirements.

You will assess needs, develop care plans with members and PCPs, educate on services and coordinate with internal and external resources, while documenting and reporting outcomes. Experience with Medi-Cal/Medicare is a plus.