Case Management - Nurse, Senior

Your Role

The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Case Management - Nurse, Senior will report to the Manager of Care Management. In this role you will play a pivotal role in assessing member needs, providing clinical education, as well as care coordination with providers, medical groups, and community resources. You will be responsible for managing and coordinating patient care, ensuring that our members receive the highest quality of care and services. Care Managers perform care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members' care including clinical nurses and treating physicians.

Your Knowledge and Experience

• Requires a current and valid CA RN License or valid RN license(s) from other state(s). Preferred licensure from a compact state. If assigned to another state, must maintain an active, unrestricted RN license in assigned state(s) or the ability to obtain required RN license (in addition to primary state license) within 90 days of hire
• Bachelor of Science in Nursing or advanced degree preferred
• Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements
• Requires 5 years experience in nursing, healthcare, or related field
• A minimum of 3 years managed care experience in inpatient, outpatient, or managed care environment preferred
• Health insurance / managed care experience preferred
• Transitions of care experience preferred
• Strong knowledge of healthcare delivery systems, managed care principles, and care coordination
• Excellent communication skills