Case Manager, RN - CA

Acentra Health, LLC•San Bernardino, CA

2d•Remote

About The Position

Acentra Health is seeking a Nurse Case Manager to evaluate beneficiaries’ needs, develop individualized care plans, and coordinate healthcare team members to support optimal client outcomes while adhering to payer requirements. The role facilitates integrated case and disease management activities based on CMSA principles, with the goal of stabilizing beneficiaries’ health and avoiding long-term care placement. This is a remote position, and candidates must reside in California; candidates in the Los Angeles or San Diego area are preferred. The position primarily involves desk work and extended use of a computer. The role also includes other duties as assigned, and its accountabilities may be expanded to include other duties related to education and experience as management deems necessary.

Requirements

Bachelor’s degree or BSN.
Active, unrestricted Registered Nurse (RN) license in California.
At least 3 years of clinical experience.
At least 1 year of case management review experience.
Must reside in California.
Effective written and verbal communication, with a strong customer-service focus and the ability to build and maintain relationships with internal and external customers.
Ability to work independently and as part of a team.
Ability to maintain a high level of confidentiality.
Ability to meet departmental metrics and goals.

Nice To Haves

Bilingual in Spanish.
Ability to assist members and conduct outreach to members without prior engagement.
Strong cultural competency and ability to work effectively with diverse populations.
Flexibility and strong organizational skills.
Ability to multitask and prioritize variable and sometimes conflicting deadlines, with strong attention to detail and demonstrated decision-making ability.
Professionalism, flexibility, and dependability under pressure.
Ability to research, identify, and apply appropriate standards of care.
Interest in continuous learning and staying informed about regulatory changes.

Responsibilities

Assess, plan, implement, monitor, and evaluate options and services to create an appropriate, individualized plan with beneficiaries across the continuum of care.
Apply clinical knowledge, communication, problem-solving, and conflict-resolution skills to support optimal beneficiary outcomes while considering client requirements.
Develop beneficiary-centered care plans.
Promote shared accountability among beneficiaries, caregivers, and providers.
Collaborate with beneficiaries, providers, and other healthcare team members to coordinate care.
Address identified gaps in care or compliance.
Maintain strict client confidentiality and comply with organizational, state, and federal confidentiality requirements.
Manage caseloads and complete required documentation and assessment-result entry in the web-based database accurately and on time, in accordance with regulatory requirements and company policies and procedures.
Maintain open communication with appropriate parties.
Pursue ongoing education, certification, and self-development to remain current with case management standards.
Understand and follow corporate policies, including those relating to HIPAA and its Privacy and Security Rules.
Perform other duties as assigned.