Registered Nurse Care Manager
About The Position
Heritage Health Network is seeking a Registered Nurse Care Manager to provide clinical oversight and guidance to non-clinical Lead Care Managers in its Enhanced Care Management program. The role reviews member charts and care plans, identifies gaps in care, and supports comprehensive, high-quality care for members with complex medical and social needs. It combines remote clinical work with field-based activities, including in-person member and provider engagement as needed. The RN Care Manager collaborates with Lead Care Managers, Behavioral Health Care Managers, Community Health Workers, healthcare providers, hospitals, and community organizations. The position also supports care transitions, participates in weekly case reviews, ensures compliance with Medi-Cal ECM guidelines and applicable regulations, maintains EHR documentation, and provides clinical input for required monthly reports.
Requirements
- Active Registered Nurse (RN) license in California.
- Minimum of 2 years of nursing experience.
- At least 1 year of experience in care management, case management, or a leadership capacity.
- Experience working with vulnerable populations and individuals with complex medical and social needs.
- Strong clinical assessment and care-planning skills.
- Proficiency with electronic medical records (EMR/EHR) systems.
- Excellent communication, collaboration, and clinical judgment skills.
- Ability and willingness to perform field-based work and in-person member engagement as required.
Responsibilities
- Review member charts in the EMR/EHR to assess care plans, medical history, and treatment adherence.
- Ensure the quality and appropriateness of care coordination for ECM members.
- Provide clinical guidance to non-clinical Lead Care Managers on complex member cases.
- Identify gaps in care and recommend interventions to improve health outcomes.
- Collaborate with Lead Care Managers, Behavioral Health Care Managers, Community Health Workers, and other multidisciplinary care team members.
- Conduct field-based visits and member engagement activities as needed to support care coordination and clinical needs.
- Participate in in-person member assessments, care coordination, and follow-up activities when appropriate.
- Partner with healthcare providers, hospitals, and community organizations to facilitate referrals and access to care.
- Coordinate with hospitals and healthcare providers to support care transitions and optimize discharge planning.
- Participate in weekly case reviews concerning high-risk members and care-management best practices.
- Ensure care-management activities align with Medi-Cal ECM guidelines and applicable healthcare regulations.
- Maintain accurate and timely documentation in the electronic health record system.
- Provide clinical input for monthly reports required by health plans and regulatory bodies.
Benefits
- Medical, dental, and vision insurance.
- Paid time off and paid holidays.
- Performance bonuses based on measurable role-specific goals.
- Hybrid work flexibility.
- Growth and professional development opportunities.
- Meaningful work supporting vulnerable Medi-Cal populations.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
