X - As-Needed / Temp - Medical Case Manager, MSSP

About the role

As-Needed/Temporary Medical Case Manager for MSSP (Multipurpose Senior Services Program) at CalOptima Health, providing case management services to members, conducting assessments, developing care plans, coordinating with providers, and ensuring compliance with regulations.

Responsibilities

• Participate in a mission-driven culture focused on high-quality performance, member service, consistency, dignity, and accountability.
• Assist the team in carrying out department responsibilities and collaborate to support short- and long‑term goals.
• Conduct in‑field, virtual, or telephonic assessments of members’ physical, psychosocial, and environmental status.
• Navigate sensitivities of completing care management work in members’ private residences.
• Build and maintain rapport with members from diverse backgrounds to support coping with complex medical, behavioral, and social needs.
• Gather and review all pertinent case information, including medical documentation; record information and clinical impressions.
• Certify clinical level of care determinations per California Code of Regulations (CCR), Title 22 Sections 51334 and 51335 for eligible applicants.
• Assess and communicate members’ status and progress; if progress stalls or regresses, determine cause and adjust care plans, providers, and services.
• Identify and respond to member crisis situations by prioritizing and implementing appropriate interventions.
• Initiate and maintain contact with members’ families, treating physicians, and other health‑care professionals to coordinate information.
• Develop, implement, and update each member’s individualized care plan through the interdisciplinary team (IDT) process with member, family, supervising care manager, and MSSP Social Worker.
• Collaborate with professionals across disciplines and community agencies to interpret and problem‑solve barriers to preferred care‑plan goals.
• Track members’ quality of care and quality‑of‑life improvements against established care‑plan goals.
• Advocate for members’ best interest regarding necessary benefit coverage, treatment alternatives, and access to care.
• Complete other projects and duties as assigned (approximately 10% of time).

Requirements

• Associate degree in nursing (ADN) plus 3 years of clinical experience working with the health needs of the population served; preferably 2 years of experience in public health with older adults, or an equivalent combination of education and experience.
• Valid driver’s license, vehicle, acceptable driving record, and current auto insurance (or other approved transportation) for work away from the primary office 50% of the time or more.
• Current unrestricted Registered Nurse (RN) license to practice in California.

Qualifications

• Bachelor of Science in Nursing (BSN) – preferred.
• Case Management Certification (CCM) – preferred.
• Public Health Nurse (PHN) certification – preferred.
• Experience in home health, hospice, or skilled nursing facility and Level of Care Certification process – preferred.
• Bilingual in English and one of CalOptima Health’s threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese) – preferred.

Skills

• Develop rapport and maintain effective working relationships with leadership, staff, and external contacts at all levels and diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, orally and in writing.
• Ability to work a flexible schedule, including evening and weekend events.
• Organized, analytical, problem‑solver with project‑management skills.
• Able to manage multiple projects and identify internal/external collaboration opportunities.
• Motivate and lead multi‑program teams and external committees/coalitions.
• Proficient with computer and appropriate software (Microsoft Office: Word, Outlook, Excel, PowerPoint) and job‑specific applications/systems.

Pay

Salary Grade 313: $90,820 – $145,312 annually ($43.66 – $69.86 per hour).

Schedule

Work Arrangement: Full Office. Work Schedule: Monday through Friday, 8:00 a.m. to 5:00 p.m. Expected Assignment Duration: up to sixty (60) days, may