Hybrid Nurse Case Manager – California HMO

Posted 1 hour ago

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About the role

  • Nurse Case Manager managing complex and chronic care for a California HMO. Assessing, implementing and evaluating care plans for member health optimization.

Responsibilities

  • performing care management within the scope of licensure for members with complex and chronic care needs
  • assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum
  • performs duties telephonically with medical groups, providers, community resources, and members for discharge planning
  • ensures member access to services appropriate to their health needs
  • conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment
  • implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements
  • coordinates internal and external resources to meet identified needs
  • monitors and evaluates effectiveness of the care management plan and modifies as necessary
  • interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans
  • assists in problem solving with providers, claims or service issues

Requirements

  • Requires BA/BS in a health related field
  • minimum of 3 years of clinical experience
  • Current, unrestricted RN license in the state of California required
  • Case Manager experience within hospital or managed care setting is preferred
  • Clinical experience working with individuals with various chronic diseases, illnesses, and medical needs strongly preferred
  • Knowledge/experience with discharge planning preferred.

Benefits

  • comprehensive benefits package
  • incentive and recognition programs
  • equity stock purchase
  • 401k contribution
  • paid holidays
  • Paid Time Off
  • short and long term disability benefits
  • medical, dental, vision benefits
  • wellness programs
  • financial education resources

Job title

Nurse Case Manager – California HMO

Job type

Experience level

Mid levelSenior

Salary

$67,200 - $115,920 per year

Degree requirement

Bachelor's Degree

Location requirements

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