Case Manager Nurse

SAN JOAQUIN COUNTY HEALTH COMMISSION•Placerville, CA

10h•$103,000 - $145,000•Remote

About The Position

The Case Manager Nurse conducts case management activities for assigned members under general supervision. The role requires analyzing, synthesizing, and evaluating data and information, and developing, implementing, and evaluating individual care plans to ensure care is delivered at the appropriate level and duration and complies with HPSJ, regulatory, and contractual requirements. Work is varied and complex and requires moderate discretion and independent judgment. This is a remote position for candidates who reside in California, preferably within the service area. Remote work is contingent on business needs and company guidelines. The position may also be performed in a hybrid or onsite setting depending on position requirements and business needs. Employees working remotely must maintain a secure, distraction-free workspace and reliable internet connectivity consistent with company standards. The employer does not sponsor visas; candidates must have valid U.S. work authorization, a Green Card, or U.S. citizenship.

Requirements

Graduation from an accredited nursing school.
At least three years of clinical experience as an RN in a hospital or clinic.
At least three years performing case management, utilization management, or discharge planning.
Unrestricted California Registered Nurse license.
Strong clinical skills consistent with California RN scope-of-practice guidelines.
In-depth knowledge and proficient skills in administering protocols for utilization management, discharge planning, and/or case management.
In-depth knowledge of healthcare delivery systems as they apply to case management.
Ability to read, interpret, and apply clinical information, practice guidelines, and other complex data and information.
Strong assessment, analysis, and problem-solving skills; basic negotiation skills.
Effective interpersonal skills with individuals inside and outside HPSJ and diverse groups.
Strong oral and written communication skills, including explaining complex information professionally and documenting to standards.
Ability to use tact and diplomacy to diffuse emotional situations.
Ability to work independently and as part of a team.
Time-management and organizational skills, including prioritizing work, attending to a broad range of activities, and meeting deadlines.
Strong customer-service skills.
Basic skills in Word and Excel.
Ability to enter data into and navigate multiple databases.
Ability to speak and be understood in English.
Ability to handle confidential information with appropriate discretion.
Within one year of hire, develop in-depth knowledge of government-sponsored programs and regulations as they apply to case management.
Within one year of hire, develop in-depth knowledge of managed-care principles, practices, and regulatory requirements as they apply to case management.
Must reside in California.
Must have legal and valid work authorization, a Green Card, or U.S. citizenship; the employer does not sponsor visas.

Nice To Haves

Proficiency in one of HPSJ’s threshold languages, as defined by its Cultural and Linguistic Program.
Maternal health experience, including prenatal and/or postnatal care.
Experience as a clinician in a managed-care setting.
Experience working with Medi-Cal and/or Medicare populations.
Certified Case Manager designation.

Responsibilities

Assess and evaluate members’ care needs.
Educate members about HPSJ services and the case management process.
Develop complex care plans in partnership with members and their primary care providers.
Collaborate with members, their families, and internal and external resources to support understanding of and compliance with care plans.
Escalate high-risk medical issues to the Medical Director for review and approve or deny services as directed.
Monitor and evaluate progress at appropriate intervals and conduct appropriate interventions.
Support and advise members in self-advocacy efforts.
Document activities in appropriate HPSJ systems according to standards.
Track data, compile data, and produce and submit routine reports.
Review care plans developed by LVN Case Managers and Entry Level Case Managers.

Benefits

Medical coverage with HMO and PPO plan options.
Employee Wellness Program supporting physical, mental, and financial well-being.
Dental and vision plans with multiple provider choices.
Paid time off accruing up to three weeks, four paid floating holidays, and nine paid holidays.
CalPERS retirement pension program, automatic employer-paid retirement contributions, and a voluntary defined contribution plan.
Flexible spending accounts for healthcare and dependent-care expenses.
Employer-paid term life and AD&D insurance.
Employer-paid disability insurance.
Employer-paid Employee Assistance Program.
Health Advocacy to help employees navigate medical care and benefits.
Voluntary supplemental benefits, including medical, legal, and identity-theft protection.
Online discount mall.
Tuition reimbursement.