RN Clinical Case Manager

Position Summary

The RN Clinical Care Manager (CCM) serves as a trusted partner and advocate for members, providing compassionate, coordinated, and person-centered care within the Enhanced Care Management (ECM) program. This role combines the relational and member-engagement strengths of the Lead Care Manager with the clinical expertise and system coordination responsibilities of an RN Case Manager.

Key Responsibilities

• Visit members in-person and virtually to conduct initial and ongoing assessments of medical, behavioral, and social needs.
• Build rapport with members and families, fostering trust and empathy to support long-term engagement and self-sufficiency in health.
• Provide compassionate emotional support, active listening, and culturally sensitive coaching to empower members in their care journey.
• Respond promptly and professionally to member inquiries, concerns, and care needs, ensuring service adherence to legal and payer guidelines.
• Develop and maintain individualized, whole-person care plans based on comprehensive assessments addressing physical health, behavioral health, substance use, long-term care, housing, and social service needs.
• Collaborate across the healthcare continuum—primary care, specialists, hospitals, behavioral health, and community agencies—to integrate medical and social support.
• Maintain monitoring member progress and outcomes, adjust care plans as needed, and ensure regular follow-up through telehealth and in-person interactions.
• Facilitate safe and effective care transitions, including discharge planning, follow-up appointments, and home-based care coordination.
• Advocate for timely access to appropriate treatments, medications, and support services.
• Review utilization patterns of high-risk patients and work with healthcare teams to design interventions that reduce avoidable hospital and ED visits.
• Analyze payer and quality performance reports to identify care gaps and implement improvement strategies.
• Participate in developing and training team members on quality improvement, safety, and case management best practices.
• Maintain compliance with Medi-Cal, HEDIS, and quality standards while advancing health equity across all populations.

Qualifications

• Current California RN license in good standing.
• 2–3 years of clinical experience in case management, acute care, ICU/CCU, or home health.
• Strong understanding of Medi-Cal, care coordination, and social determinants of health.
• Excellent analytical, clinical judgment, interpersonal, and communication skills.
• Proficiency in MS Office (Excel, Word, Outlook) and electronic health record systems.
• Valid California driver’s license, car insurance, and access to a reliable vehicle.
• Ability to travel locally for member visits; mileage reimbursement provided.
• Compassionate, nonjudgmental, and culturally sensitive approach.

Preferred

• Bachelor’s or Associate degree in Nursing, Healthcare Administration, or a related field.
• Bilingual, Spanish.
• Certified Case Manager (CCM) or equivalent certification.
• Experience in Managed Care, Community Health, or Behavioral Health settings.
• Certification or experience using Motivational Interviewing or empathy-based communication strategies.
• Familiarity with regional health disparities and principles of self-management support for chronic conditions.

Physical and Work Requirements

• Prolonged periods sitting at a desk or driving for community visits.
• Frequent computer usage; must be able to lift up to 10 pounds.
• Occasional evening or weekend work within a 40-hour week.

Pay and Benefits

The pay range for this position is $90,000 USD - $110,000 USD. Full-time employees are eligible for the following benefits enrollment after 60 days of employment:

• Medical, Dental, & Vision Benefits
• Short & Long-Term Disability Benefits
• Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans
• Flexible Spending Accounts
• Employee Assistance Program (EAP)
• 401(K)
• Paid Vacation and Sick Leave
• Paid Holidays
• Employee Referral Program
• Company Discount Program

Equal Employment Opportunity

Optima Medical Management Group and its divisions are an Equal Opportunity Employer. We are committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state or local laws.