TOC RN II: Hybrid Care Coordinator for Complex Transitions

Clever Care Health Plan; Huntington Beach (CA); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Clever Care Health Plan in Southern California seeks a Transitions of Care Registered Nurse II (TOC RN II) to lead complex care coordination across inpatient to community settings. You will independently manage a heavy caseload, mentor staff, and collaborate with Medical Directors, Utilization Management, and Quality teams to improve member outcomes.

The role emphasizes evidence-based practices, CMS compliance, NCQA accreditation, and health equity.

Qualifications

• Active, unrestricted California RN license.
• Minimum of four (4) years of progressive clinical nursing experience.
• Minimum of two (2) years of experience in Care Management, Case Management, Utilization Management, Population Health, Managed Care, Transitional Care, or related clinical specialty.
• Medicare Advantage or health plan experience preferred.

Responsibilities

• Perform comprehensive clinical assessments for members during transitions of care.
• Independently manage a complex caseload requiring advanced clinical assessment and coordination.
• Develop, implement, evaluate, and revise transition care plans based on member needs.
• Complete medication reconciliation and promote safety and adherence.
• Coordinate services across hospitals, physician practices, and community providers.
• Mentor newly hired nurses and participate in ICT meetings.

Skills

Medicare Advantage

Care coordination

Transitions of care

Mentoring

Regulatory compliance

Education

California RN license

Tools

EHR proficiency

Job description

Clever Care Health Plan in Southern California seeks a Transitions of Care Registered Nurse II (TOC RN II) to lead complex care coordination across inpatient to community settings. You will independently manage a heavy caseload, mentor staff, and collaborate with Medical Directors, Utilization Management, and Quality teams to improve member outcomes.

The role emphasizes evidence-based practices, CMS compliance, NCQA accreditation, and health equity.