Case Manager (Bilingual Mandarin, Korean, or Spanish)

Clever Care Health Plan•Huntington Beach, CA

5d•$90,000 - $100,000•Onsite

About The Position

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. Who Are We? ✨ Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. Why Join Us? 🏆 We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. Job Summary The role of the Case Manager is to promote quality, cost-effective outcomes for an assigned population by facilitating collaboration and coordination across settings, assessing member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member's receive services and resources required to meet desired health and social outcomes. The Case Manager ensures members progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. The Case Manager is responsible for providing patient centered care across the care continuum.

Requirements

Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license issued by the California BRN required.
2-3 years in case management, disease management, managed care, or medical or behavioral health settings
High level of critical thinking and problem-solving skills
Strong work ethic and overall positive attitude
Effective communication skills including verbal and written
Ability to manage time effectively, understand directions, and work independently in a fast-paced environment
Demonstrated flexibility, organization, and self-motivation
Highly adaptable to change

Nice To Haves

Certified Case Manager (CCM) preferred
Certified Managed Care Nurse (CMCN) preferred
Bilingual in Mandarin/Cantonese, Vietnamese, or Korean, preferred

Responsibilities

Assessment of the medical, social, and behavioral needs of an assigned population
Completes comprehensive assessments of members per regulated timelines and determines who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and triggers identified in the assessment.
Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals.
Conducts telephonic, and face-to-face/virtual visits as required.
Performs ongoing monitoring of the care plan to evaluate effectiveness of interventions for goal achievement, suggest changes as needed and document updates accordingly.
Maintains ongoing member caseload for regular outreach and management.
Promotes integration of services for members including behavioral health care and longterm services and supports/home and community to enhance the continuity of care for Clever Care members.
Uses motivational interviewing and Clever Care clinical guidelines to educate, support and motivate change during member contacts.
Assesses barriers to care, provides care coordination, and assistance to members to address concerns.
Additional duties, as assigned.