Case Manager, RN (Work from Home)

Back to Career Site Our mission is to reputed company reputed company right. Together. We are a value-driven reputed company company committed to providing personalized care to aging and underserved populations. We do this by aligning stakeholders across the reputed company ecosystem. Together, we can improve consumer experience, optimize clinical reputed company, and reduce total cost of care. What drives our mission? The company values we live and breathe every day. We reputed company it simple : Be reputed company. Be reputed company. Be Accountable. Be Inclusive. Be Collaborative. If you reputed company our passion for changing reputed company so reputed company people can live healthy, brighter lives – apply to join reputed company. SCOPE OF ROLE The role of the Case Manager is to promote quality, cost-effective reputed company for a population by facilitating collaboration and coordination across settings, assessing member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure members receive services and resources required to meet desired health and reputed company reputed company. The Case Manager is responsible for providing patient-centered care across the care continuum. ROLE RESPONSIBILITIES

• Assessment of the medical, reputed company, and behavioral needs of an assigned population
• Care Plan development and prioritization to transition members to reputed company reputed company of health and self-management.
• reputed company to coordinate interdisciplinary team meetings as required
• Collaboration across providers and reputed company settings to ensure reputed company quality reputed company for an assigned population
• reputed company transition of care interventions as required
• Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population.
• Facilitate linkage to appropriate community resources to address reputed company determinants of health
• reputed company to adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across reputed company care setting
• reputed company to ensure member communication and notices are composed in a manner consistent with regulatory standards.
• Adheres to the Policies and Procedures set forth by the Quality Management Committee. EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
• Associate’s degree in Nursing, Bachelor’s degree preferred
• Minimum two (2) years of experience in medical management clinical functions.
• Working knowledge of MCG, InterQual, and NCQA standards LICENSURES AND CERTIFICATIONS
• Active and Unrestricted License as a Registered Nurse (RN) in the state of California
• Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred WORK ENVIRONMENT
• The majority of work responsibilities are performed in an reputed company office setting, carrying out detailed work sitting at a desk / table and working on the computer.
• Some travel may be required. For individuals assigned to a location(s) in California, reputed company Health is required by law to include a reasonable estimate of the compensation reputed company for this position. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the reputed company is $72,068 - $108,104 annually. Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; Paid Time Off, and paid holidays. As an Equal Opportunity Employer, we welcome and reputed company a diverse employee group committed to meeting the needs of reputed company Health, our consumers, and the communities we serve. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Apply tot his job

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