Senior Complex Case Manager - D-SNP (RN) (Temporary)
About The Position
This is a temporary position and the length of assignment is estimated to go from April 2026 through December 2026. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. There is 1 full-time (40 hours/week) opportunities available for this temporary assignment. Reporting to the Medicare Care Management Manager (RN), this position: Develops and manages an individualized comprehensive plan of care for Medicare Dual Eligible Special Needs Plan (D-SNP) members referred into the Case Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner Works with and educates members, families, providers, external agencies, and internal departments on the D-SNP Case Management Program Participates in Quality Improvement studies, to continually evaluate the program’s effectiveness and ability in promoting quality driven, cost effective, achievable goals and outcomes for members Performs D-SNP Program oversight and support activities Acts as a liaison between the D-SNP Program and providers and community agencies to promote effective implementation of program objectives and requirements
Requirements
- Current unrestricted license as a Registered Nurse issued by the State of California
- Associate’s degree in Nursing and a minimum of seven years of experience in a patient care setting, including a minimum of one year of case management experience (a Bachelor’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
- A minimum of one year of the required patient care experience must be in an acute or outpatient environment, working with adults and/or dual-eligible populations
- Knowledge of: The principles and practices of clinical nursing
- Knowledge of: The principles and practices of case management, including motivational interviewing and evidence-based guidelines
- Knowledge of: Care management and coordination
- Knowledge of: Complex chronic conditions, geriatric care, and psychosocial factors impacting health outcomes
- Knowledge of: The principles and practices of developing and implementing health improvement strategies to address social determinants of health
- Knowledge of: Evidence-based practice guidelines in the development of care plans
- Knowledge of: Electronic health record and/or care management platforms
- Ability to: Assess member risk, define problems, develop care plans, and collaborate across disciplines
- Ability to: Demonstrate strong critical thinking and problem-solving skills
- Ability to: Interpret and apply policies and regulations
- Ability to: Define issues, conduct research, interpret data, and identify and evaluate options
- Ability to: Evaluate medical records and other health care data
- Ability to: Organize work, manage complex priorities, and document with accuracy and timeliness
- Ability to: Communicate effectively with a diverse population of members, including those with behavioral health issues
Responsibilities
- Develops and manages an individualized comprehensive plan of care for Medicare Dual Eligible Special Needs Plan (D-SNP) members referred into the Case Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner
- Works with and educates members, families, providers, external agencies, and internal departments on the D-SNP Case Management Program
- Participates in Quality Improvement studies, to continually evaluate the program’s effectiveness and ability in promoting quality driven, cost effective, achievable goals and outcomes for members
- Performs D-SNP Program oversight and support activities
- Acts as a liaison between the D-SNP Program and providers and community agencies to promote effective implementation of program objectives and requirements
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
251-500 employees
