Nurse Case Manager II - California
About The Position
The Nurse Case Manager II provides care management, within the scope of licensure, to members with complex and chronic care needs. The role assesses, develops, implements, coordinates, monitors, and evaluates care plans to optimize member health care across the care continuum. Duties are performed telephonically or on-site, such as at hospitals for discharge planning. This is a virtual full-time role for associates located in California, except for required in-person training sessions. The schedule is 9:00 a.m.–5:30 p.m. Pacific time, with one or two evening shifts (11:30 a.m.–8:00 p.m. Pacific time) per week; one late shift per month must be on Friday.
Requirements
- A BA/BS in a health-related field and at least 5 years of clinical experience, or an equivalent combination of education and experience.
- Current, active, unrestricted RN license in applicable state(s).
- Multi-state licensure is required if providing services in multiple states.
Nice To Haves
- Certification as a Case Manager.
- A BS in a health or human services-related field.
Responsibilities
- Ensure members have access to services appropriate to their health needs.
- Conduct assessments to identify individual needs and develop care management plans with objectives and goals.
- Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements.
- Coordinate internal and external resources to meet identified needs.
- Monitor and evaluate care management plans and modify them as necessary.
- Interface with Medical Directors and Physician Advisors to develop care management treatment plans.
- Negotiate reimbursement rates, as applicable.
- Help resolve provider, claims, or service issues.
- Assist with developing utilization and care management policies and procedures.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 401(k) contribution and matching.
- Merit increases.
- Paid holidays.
- Paid time off.
- Incentive bonus programs, unless covered by a collective bargaining agreement.
- Medical insurance.
- Dental insurance.
- Vision insurance.
- Short- and long-term disability benefits.
- Life insurance.
- Wellness programs.
- Financial education resources.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
