Case Manager II, RN

Clever Care Health Plan•Huntington Beach, CA

1d•$88,355 - $100,000•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 experienced Case Manager II – RN is responsible for managing a caseload of moderate to high-complexity members, including those with multiple chronic conditions, behavioral health needs, and SDOH barriers. Functions independently with minimal supervision and serves as a clinical resource to CM I staff.

Requirements

Active, unrestricted California RN license.
3–5 years of case management or managed care experience.
Experience managing high-acuity populations.
Strong critical thinking and problem-solving skills.
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
Must be able to travel when needed or required
Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs. Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.

Nice To Haves

Certified Case Manager (CCM) preferred
Certified Managed Care Nurse (CMCN) preferred
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.
Manages high-risk, high-utilization, and complex members.
Leads interdisciplinary care team (ICT) conferences for assigned members.
Performs advanced clinical assessments and identifies gaps in care.
Serves as primary Transitions of Care (TOC) lead for assigned caseload.
Interprets risk stratification data (ACG, HRA, quality metrics) to prioritize outreach.
Identifies quality gap opportunities and collaborates with Quality to support closure.
Mentors and provides guidance to Case Manager I staff.
Assists with audit preparation and regulatory compliance initiatives.
Identifies trends impacting quality, utilization, and member outcomes.
Reviews risk stratification data (ACG, HRA, utilization reports) to prioritize outreach.
Participates in quality improvement and performance initiatives.
Mentors and provides guidance to Case Manager I staff.
Serves as lead for designated CM programs (e.g., TOC, SNP compliance tracking, CCM workflow).
Supports development and refinement of care management workflows.
Monitors adherence to assigned program timelines and documentation standards.
Provides subject matter expertise during cross-departmental meetings.
Identifies operational improvement opportunities and escalates system gaps.
Additional duties, as assigned.