Remote RN Medical Case Manager, CalAIM

CalOptima; Orange (CA); Hybrid; USD 91,000 - 145,000; Full time

Benefits offered by this job

Generous PTO

Wellness programs

Tuition reimbursement

Flexible scheduling

Career development opportunities

Job summary

CalOptima is seeking a Medical Case Manager (RN) for the CalAIM program to review authorizations, coordinate referrals, and collaborate with health networks. The role supports remote and part-time in-office attendance with primary responsibilities in California.

The ideal candidate holds an RN license, ADN or BSN, and experience in managed care or authorization reviews. Bilingual skills are a plus, and the team emphasizes high-quality service and equity in care.

Qualifications

• Associate degree in nursing (ADN) plus 3 years nursing experience required; may count education equivalently.
• RN license in the state of California required; BSN is a plus.
• Bilingual in English and one threshold language (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese) is a plus.

Responsibilities

• Review and process authorization and notification of CalAIM services.
• Authorize referral requests using CalAIM criteria and policies.
• Coordinate member care with health networks and providers.
• Document data entries accurately in UM/CM systems.
• Interact with provider callers and respond to inquiries to support access to care.

Skills

RN license required

Nursing experience

Managed care experience

Authorization review experience

Bilingual English + Spanish

Education

ADN + 3 years nursing experience

BSN preferred

RN license in California

Tools

Microsoft Office

CalOptima Health Connect

Job description

CalOptima is seeking a Medical Case Manager (RN) for the CalAIM program to review authorizations, coordinate referrals, and collaborate with health networks. The role supports remote and part-time in-office attendance with primary responsibilities in California.

The ideal candidate holds an RN license, ADN or BSN, and experience in managed care or authorization reviews. Bilingual skills are a plus, and the team emphasizes high-quality service and equity in care.