About The Position

We are seeking a Registered Nurse to support care coordination, patient engagement, and clinical oversight for patients receiving enhanced care management and wraparound support services. This role is ideal for an RN with strong clinical judgment, care coordination experience, and a passion for improving outcomes for patients with complex medical, behavioral, and social needs. The Registered Nurse will help guide care recommendations, support transitions of care, collaborate with multidisciplinary teams, and ensure patients are connected to the right clinical, social, and community-based resources.

Requirements

  • Active Registered Nurse license in California
  • Strong understanding of clinical care planning, patient engagement, and care transitions
  • Knowledge of social determinants of health and community resource navigation
  • Ability to support patients with complex medical, behavioral, and social needs
  • Strong communication, documentation, and organizational skills
  • Comfortable collaborating with physicians, care teams, leadership, and community-based partners
  • Ability to work independently while supporting a multidisciplinary care model

Nice To Haves

  • Experience in care coordination, case management, population health, enhanced care management, or similar patient support programs preferred
  • Knowledge of Motivational Interviewing, Trauma-Informed Care, Harm Reduction, and Stages of Change preferred

Responsibilities

  • Serve as a clinical resource and subject matter expert for care coordination and enhanced care management programs
  • Provide care recommendations within the scope of the Registered Nurse license and under appropriate physician oversight
  • Support clinical assessments that contribute to individualized care plan development
  • Promote patient engagement, education, and follow-through with care plans
  • Conduct telephonic outreach and patient visits as needed based on program needs
  • Support transitions of care, including post-discharge follow-up and engagement with high-risk patients
  • Reinforce provider recommendations and care plans during patient interactions
  • Coordinate services such as primary care, specialty care, labs, durable medical equipment, behavioral health, and community-based resources
  • Assess environmental, social, and functional barriers to care and help coordinate appropriate interventions
  • Participate in multidisciplinary team meetings
  • Collaborate with leadership to support care model improvements
  • Identify and escalate clinical or social concerns to the appropriate team members
  • Perform chart audits in accordance with company, regulatory, and compliance standards
  • Maintain compliance with HIPAA, company policies, and documentation requirements
  • Perform other duties as assigned based on program and organizational needs

Benefits

  • Medical, dental, and vision benefits
  • 401(k) plan
  • Paid time away: 3 weeks total
  • 2 weeks PTO
  • 6-7 company-recognized federal holidays
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