Case Manager I - RN

Clever Care Health Plan•Huntington Beach, CA

8d•Hybrid

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 Case Manager I – RN is responsible for managing a defined caseload of members. Under general supervision, the Case Manager I conducts assessments, develops care plans, and coordinates services to promote quality outcomes and continuity of care.

Requirements

Active, unrestricted California RN license required.
1+ years of experience in case management, managed care, or clinical setting.
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

Bilingual in Mandarin/Cantonese, Vietnamese, Spanish, or Korean, preferred

Responsibilities

Conducts comprehensive assessments within regulatory timelines.
Identifies members appropriate for case management using established criteria and clinical guidance.
Develops and implements individualized care plans in collaboration with the member, caregiver, and interdisciplinary team.
Performs telephonic and virtual outreach; face-to-face visits as required.
Monitors care plan progress and documents interventions timely and accurately.
Coordinates medical, behavioral health, and community-based services.
Provide clinical education and self-management coaching.
Addresses barriers to care including transportation, medication access, and social determinants.
Serves as primary Transitions of Care (TOC) lead for assigned caseload.
Escalates high-risk or complex cases to senior staff as appropriate.
Maintains assigned caseload and meets productivity and compliance standards.
Participates in team meetings and interdisciplinary care team meetings.
Additional duties as assigned.