Remote Rn Case Manager, Outpatient (Must Have California Rn License)

Overview of the Role:

Alignment Health is seeking a remote, telephonic, RN Case Manager to join the outpatient case management team.  As an RN Case Manager, you will be responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs.  You will also deliver care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants. The Case Manager will assist with closing gaps in care and resolving barriers that prevent members from attaining improved health. The Case Manager will connect with members telephonically.   

Responsibilities:

• Coordinate care by serving as a resource for the member, their family and their physician.
• Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.
• Complete comprehensive assessments within their scope of practice that includes assessing the member's current health status, resource utilization, past and present treatment plan and services.
• 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.
• Provide education and self-management support based on the member's unique learning style.
• Assists 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. 

Required Skills and Experience:

• Minimum 1-3 years' clinical experience,
• Minimum 2 years case management experience; or any combination of education and experience, which would provide an equivalent background.
• Health plan experience preferred
• Must have and maintain an active, valid, and unrestricted RN license in California
• 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
• Bilingual English and Spanish, Chinese, or Vietnamese preferred
• Excellent verbal and written communications skills
• Team player who builds effective working relationships
• Able to work independently
• Experience using standardized clinical guidelines required
• Strong organizational skills
• Strong proficiency in Microsoft Office suite (Word, Excel, PowerPoint, etc.)

Pay range: $78,000 - $105,000 annually.