Telephonic RN Case Manager, SNP (Bilingual Preferred)

About the role

The fully remote RN Case Manager SNP is responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs. This role requires a strong background in case management, excellent communication skills, and a passion for improving the quality of life for seniors.

Responsibilities

• Serves as a resource for the member, their family, and their physician.
• Ensures access to appropriate care for members with urgent or immediate needs.
• Completes comprehensive assessments within their scope of practice.
• Collaborates with the member, the PCP, and other members of the care team to implement a plan of care.
• Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on the development of care management treatment plans.
• Provides education and self-management support based on the member’s unique learning style.
• Aids in problem solving with providers, claims or service issues.
• Works closely with delegated or contracted providers, groups, or entities to assure effective and efficient care coordination.
• Maintains confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy.
• Supervises other team members as needed.

Requirements

• Minimum 2 years' clinical experience
• Minimum 1 year case management experience
• Health Plan experience preferred
• Successfully passed Post High School courses to obtain an RN licensure or AS in Nursing
• Bachelor's degree in Nursing preferred
• Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
• Extensive knowledge of the management of chronic conditions
• Effective written and oral communication skills
• Ability to communicate positively, professionally and effectively with others
• Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPoint
• Ability to perform mathematical calculations and calculate simple statistics correctly
• Advanced problem-solving and organizational skills
• Ability to work in a fast-paced environment

Specialized Skills

• Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
• Extensive knowledge of the management of chronic conditions
• Effective written and oral communication skills
• Ability to communicate positively, professionally and effectively with others
• Provide leadership, teach and collaborate with others
• Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPoint
• Ability to perform mathematical calculations and calculate simple statistics correctly
• Advanced problem-solving and organizational skills
• Ability to work in a fast-paced environment

Experience

• Minimum 2 years' clinical experience
• Minimum 1 year case management experience
• Preferred Health Plan experience

Education

• Successfully passed Post High School courses to obtain an RN licensure or AS in Nursing
• Bachelor's degree in Nursing preferred

Licenses and Certifications

• Must have and maintain an active, valid, and unrestricted RN license in California (Non-Compact)
• Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pay Range

$77,905.00 - $116,858.00