RN, Care Manager

VVIPA MEDICAL GROUP, INC; Victorville (CA); Hybrid; USD 88,000 - 97,000; Full time

Benefits offered by this job

401(k) eligibility

Paid time off

Sign-on bonus or discretionary awards

Job summary

Heritage Victor Valley Medical Group seeks an RN Care Manager to provide clinical leadership in care management, design SMART care plans, and oversee LVN activities. You will evaluate HRAs, coordinate multidisciplinary care, and ensure safe transitions of care following NCQA and CMS guidelines.

Responsibilities include leading IDT reviews, managing high-acuity caseloads, and ensuring medical necessity and service utilization align with payor standards.

Qualifications

• High School Diploma or equivalent.
• Graduate from an accredited Registered Nurse Program or higher.
• Current CPR, BLS and/or ACLS.
• Knowledge of Microsoft Office.
• 2 years as a Clinical Nurse (Acute Care, Skilled Care, CM or IM medical office location).
• 1 year Care Management, Acute care or Skilled Care or equivalent.
• Excellent verbal and written communication skills, critical thinking.
• Electronic Medical Records.
• Ability to handle and prioritize tasks to meet deadlines and productivity goals.
• Ability to handle confidential matters.
• Ability to work in a multi-task, high-stress environment.
• Position may be full or hybrid telecommuting.

Responsibilities

• Provide clinical direction and oversight for LVN case management activities.
• Synthesize data to establish comprehensive clinical baseline profiles for complex members.
• Conduct independent clinical assessments and develop SMART care plans.
• Periodically review and modify care plans based on progress and input.
• Manage high-acuity member caseloads and multi-morbid conditions.
• Perform post-discharge clinical assessments and safe handoffs.
• Lead and participate in IDT meetings to present complex cases.
• Evaluate medical necessity per guidelines (e.g., Milliman/InterQual).
• Coordinate specialized support services and referrals to address gaps.

Skills

Communication

Critical thinking

Multitasking

Time management

Confidentiality

Education

RN program graduate

High School Diploma or equivalent

CPR/BLS/ACLS certification

Tools

Microsoft Office

Job description

The RN Care Manager provides clinical leadership and decision-making for care management in accordance with NCQA standards, CMS guidelines, health plan contracts, and company policy. The RN is responsible for conducting comprehensive clinical assessments, medication reconciliation, evaluating data gathered by LVNs, and analyzing health plan–completed Health Risk Assessments (HRAs) to design and approve individualized S.M.A.R.T. care plans. Operating as the clinical escalation lead, the RN provides operational guidance and oversight for LVN team members, leads Interdisciplinary Team (IDT) reviews, and collaborates with multidisciplinary providers to manage complex chronic conditions, prevent unnecessary hospitalizations, and ensure safe transitions of care.

• Provide clinical direction and oversight for LVN case management activities. Synthesize clinical, psychosocial, and functional data gathered by LVNs, along with health plan–completed HRAs, to establish comprehensive clinical baseline profiles for complex members.
• Conduct independent clinical assessments and develop, evaluate, and formally complete individualized S.M.A.R.T. (Specific, Measurable, Attainable, Realistic, Time-Bound) care plans, establishing appropriate goals and evidence-based interventions.
• Periodically review and modify care plans based on member progress, clinical changes, or input from LVN follow-ups, providing required signoffs and documentation in the EMR.
• Manage high-acuity member caseloads—including multi-morbid conditions such as CHF, CAD, CKD, Diabetes, COPD, Cancer, and Dementia—monitoring outcomes and adjusting interventions to optimize health stability.
• Perform post-discharge clinical assessments following transitional nurse calls for complex members, ensuring safe care handoffs, medication reconciliation, and readmission-prevention strategies.
• Lead and participate in Interdisciplinary Team (IDT) meetings with PCPs, medical directors, and specialists to present complex cases and establish collaborative, cross-functional care strategies.
• Evaluate requests for medical necessity, authorization compliance, and service utilization using approved clinical guidelines (e.g., Milliman/InterQual), ensuring care matches payor and regulatory standards.
• Recommend and coordinate specialized support services (e.g., LCSW, Respiratory Therapy, Home Health) and facilitate provider orders and referrals to address care gaps and social determinants of health.
• Maintain thorough clinical documentation of assessments, care plans, IDT decisions, and health plan communications in the EMR within strict regulatory timeframes.
• Perform all other duties as assigned.

The pay range for this position at commencement of employment is expected to be between $63.86 and $70.74 hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. The total compensation package for this position may also include other elements, including a sign‑on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

Requirements

• Education: High School Diploma or equivalent.
• Education: Graduate from an accredited Registered Nurse Program or higher.
• Certification: Current CPR, BLS and/or ACLS
• Knowledge: Microsoft Office
• Experience: 2 years as a Clinical Nurse (Acute Care, Skilled Care, CM or IM medical office location)
• Experience: 1 year experience of Care Management, Acute care or Skilled Care or equivalent.
• Skills: Excellent verbal and written communication skills, critical thinking
• Experience: Electronic Medical Records
• Skills: Ability to handle and prioritize tasks in order to meet all given deadlines and productivity goals.
• Skills: Ability to responsibly handle matters of a confidential nature.
• Skills: Ability to work in a multi-task, high-stress, environment.
• Other: At the discretion of HVVMG management, this position has the potential to be a full or hybrid telecommuting position.

Heritage Victor Valley Medical Group

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