Senior Complex Case Manager (RN) - D-SNP (Temporary)
About The Position
This is a temporary, full-time (40 hours/week) assignment estimated to last from July 2026 through December 2026, dependent on business needs. While the assignment is with the Alliance, the selected candidate will be an employee of a temporary employment agency. The role focuses on developing and managing individualized comprehensive care plans for Medicare Dual Eligible Special Needs Plan (D-SNP) members to promote optimal outcomes in a cost-effective manner. This includes educating members, families, providers, and agencies, participating in quality improvement studies, and performing D-SNP Program oversight. The position acts as a liaison between the D-SNP Program and external entities to ensure effective implementation of program objectives.
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
Benefits
- Medical, Dental and Vision Plans
- Ample Paid Time Off
- 12 Paid Holidays per year
- 401(a) Retirement Plan
- 457 Deferred Compensation Plan
- Robust Health and Wellness Program
- Onsite EV Charging Stations
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Associate degree
