Senior Complex Case Manager (RN) - D-SNP

Doist; California (MO); Hybrid; USD 120,000 - 140,000; Full time

Benefits offered by this job

Medical, Dental and Vision Plans

Ample Paid Time Off

12 Paid Holidays per year

401(a) Retirement Plan

457 Deferred Compensation Plan

Wellness Program

Onsite EV Charging Stations

Job summary

Central California Alliance for Health in California is seeking a Senior Complex Case Manager (RN) to lead care planning for Medicare Dual Eligible members within the Care Management Department.

You will collaborate with members, families, providers, and agencies to implement effective, cost-conscious care and improve outcomes in a hybrid work setting. California RN license required with substantial clinical and case-management experience.

Qualifications

• Current unrestricted California RN license.
• Associates degree in Nursing required; a Bachelor's may substitute for part of experience.
• Minimum seven years in patient care with at least one year in case management.
• Experience in acute or outpatient settings with adults and dual-eligible populations.

Responsibilities

• Develops and manages an individualized care plan for D-SNP members.
• Educates members, families, providers, and agencies on the D-SNP Case Management Program.
• Participates in Quality Improvement studies to evaluate program effectiveness.
• Performs D-SNP program oversight and support activities.
• Liaises between the D-SNP Program, providers, and community agencies.

Skills

Nursing principles

Case management

Care coordination

Chronic condition care

Social determinants

EHR platforms

Education

California RN license

Associate’s degree in Nursing

Bachelor’s degree may substitute for 2 years experience

Tools

Electronic health records

Job description

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful consideration. That’s why we do not use AI or automated systems to review applications. Every application is reviewed by a real human member of our team. Because we take the time to give each submission the attention it deserves, our review process may take a little longer — and we genuinely appreciate your patience as we work through applications carefully and respectfully.

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply, we do give priority to those who live in, or near, our service counties: Santa Cruz, Monterey, Merced, San Benito, and Mariposa. Our mission of accessible, quality health care guided by local innovation leads everything we do, and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

There are 2 positions available as a Senior Complex Case Manager (RN) within the Care Management Department at the Alliance.

WHAT YOU\'LL BE RESPONSIBLE FOR

Reporting to the Medicare Care Management Manager (RN), this position:

• Develops and manages an individualized comprehensive plan of care for Medicare Dual Eligible Special Needs Plan (D-SNP) members referred into the Case Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner


• Works with and educates members, families, providers, external agencies, and internal departments on the D-SNP Case Management Program


• Participates in Quality Improvement studies, to continually evaluate the program’s effectiveness and ability in promoting quality driven, cost effective, achievable goals and outcomes for members


• Performs D-SNP Program oversight and support activities


• Acts as a liaison between the D-SNP Program and providers and community agencies to promote effective implementation of program objectives and requirements

ABOUT THE TEAM

The Care Management Department\'s mission is to coordinate care and empower members to achieve their health and wellness goals through collaboration and by facilitating member relationships with community providers. We bring the voice of the member into the room when collaborating with our fellow departments at the Alliance.

WHAT YOU\'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here.

• Knowledge of: The principles and practices of clinical nursing


• The principles and practices of case management, including motivational interviewing and evidence-based guidelines


• Care management and coordination


• Complex chronic conditions, geriatric care, and psychosocial factors impacting health outcomes


• The principles and practices of developing and implementing health improvement strategies to address social determinants of health


• Evidence-based practice guidelines in the development of care plans


• Electronic health record and/or care management platforms

• Ability to: Assess member risk, define problems, develop care plans, and collaborate across disciplines


• Demonstrate strong critical thinking and problem-solving skills


• Interpret and apply policies and regulations


• Define issues, conduct research, interpret data, and identify and evaluate options


• Evaluate medical records and other health care data


• Organize work, manage complex priorities, and document with accuracy and timeliness


• Communicate effectively with a diverse population of members, including those with behavioral health issues

Education and Experience

Current unrestricted license as a Registered Nurse issued by the State of California

Associate’s degree in Nursing and a minimum of seven years of experience in a patient care setting, including a minimum of one year of case management experience (a Bachelor’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

A minimum of one year of the required patient care experience must be in an acute or outpatient environment, working with adults and/or dual-eligible populations

OTHER INFORMATION

We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

COMPENSATION INFORMATION

• Zone 1 Pay Range: $125K - $140K Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas


• Zone 2 Pay Range: $120K - $135K Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role, answer any questions that you have, or share the applicable pay zone for your location if it’s not one of the typical areas listed. You can reach out to [e-mail], and a member from our Talent Acquisition team will be in touch. The hiring ranges represent a good-faith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate\'s qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).

OUR BENEFITS

Available for all regular Alliance employees working more than 30 hours per week. Some benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

• Medical, Dental and Vision Plans


• Ample Paid Time Off


• 12 Paid Holidays per year


• 401(a) Retirement Plan


• 457 Deferred Compensation Plan


• Robust Health and Wellness Program


• Onsite EV Charging Stations

ABOUT US

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us. Join us at Central California Alliance for Health (the Alliance), where you will be part of a culture that is respectful, diverse, professional and fun, and where you are empowered to do your best work. As a regional non-profit health plan, we serve members in Mariposa, Merced, Monterey, San Benito and Santa Cruz counties. To learn more about us, take a look at our Fact Sheet. The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status. We are an E-Verify participating employer At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time, ongoing basis without current or future needs for any type of employer supported or provided sponsorship.