Bilingual RN Case Manager, SNP - Must have California RN License (Non-Compact) Remote

Alignment Health•California Corporate Office, CA

11d•$77,905 - $116,858•Remote

About The Position

Alignment Health is seeking a Remote RN Case Manager for its Special Needs Plan (SNP). The role provides health care management and coordination, within the scope of licensure, for members with complex and chronic care needs. The case manager delivers care using the nursing process and interacts with members, caregivers, and interdisciplinary team participants to help close gaps in care and resolve barriers to improved health. Member outreach and connections are conducted by telephone. The position requires working from 8:00 a.m. to 5:00 p.m. Pacific Time. The employee must hold an active, valid, unrestricted California RN license (Non-Compact) and be willing to obtain specified additional state licensure immediately upon hire; the company reimburses those additional licensure costs.

Requirements

At least 2 years of clinical experience.
At least 1 year of case management experience.
Successfully completed post-high-school courses to obtain RN licensure or an Associate of Science in Nursing.
Active, valid, unrestricted California RN license (Non-Compact), which must be maintained.
Willingness to obtain LVN and/or RN licensure in Nevada (Non-Compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) immediately upon hire; the company reimburses these costs.
Strong understanding of community resources, treatment options, home health, funding options, and special programs.
Extensive knowledge of chronic condition management.
Effective written and oral communication skills and ability to build constructive relationships with diverse members, management, employees, and vendors.
Ability to communicate positively, professionally, and effectively; provide leadership; teach; and collaborate.
Ability to use PC-based software, including Word, Excel, and PowerPoint.
Ability to perform mathematical calculations and correctly calculate simple statistics.
Ability to prioritize multiple tasks, solve complex problems, use advanced reasoning, analyze data, establish facts, draw valid conclusions, and design, implement, and manage appropriate resolutions.
Effective problem-solving, organizational, and time-management skills, including the ability to work in a fast-paced environment.
Ability to comprehend and analyze statistical reports.

Nice To Haves

Health plan experience.
BSN or bachelor’s degree.

Responsibilities

Coordinate care as a resource for members, their families, and their physicians.
Help members with urgent or immediate needs access appropriate care by facilitating referrals and authorizations within the benefit structure.
Complete comprehensive assessments within the scope of practice, including assessment of current health status, resource utilization, past and present treatment plans, and services.
Collaborate with members, primary care physicians, and other care team members to implement plans of care.
Work with primary care physicians, hospitalists, nurse practitioners, and specialists to develop care management treatment plans.
Provide education and self-management support tailored to each member’s learning style.
Help resolve provider, claims, or service issues.
Work with delegated or contracted providers, groups, and entities to support effective and efficient care coordination.
Maintain confidentiality of protected health information in compliance with state and federal law and company policy.