Case Manager – Nurse RN

Job Description: Provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participantsContact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needsUse claims processing tools to review and research paid claim data to develop a clinical picture of a member's health and identify for participation in appropriate programsDevelop treatment plan for standard and catastrophic casesMonitor interventions and evaluate the effectiveness of the treatment plan in a timely mannerReport measurable outcomes that record effectiveness of interventionsInitiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of careAdvocate for the patient by facilitating the delivery of quality patient careNegotiate and implement cost management strategies to affect quality outcomesMaintain complete and detailed documentation of case managed patientsRequirements: Graduation from an accredited Registered Nursing (RN) programPossession of a current California RN license; a multi-state license will also be requiredMinimum of five (5) years medical/surgical or acute care experience, including two years' experience in case management, or an equivalent combination of education and experiencePrior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case managementKnowledge of medical claims and ICD-10, CPT, HCPCS codingAbility to critically evaluate claims data and determine treatment planDischarge planning experienceAbility to work independently making decisions and problem solvingKnowledge of community resources and alternate funding programsComputer proficiency or working knowledge of Microsoft Office SuiteExcellent interpersonal, communication and negotiation skillsStrong customer orientationGood time management skills and highly organizedBenefits: Competitive base salary and benefits effective day oneComprehensive medical and dental through our own health solutions (yes, we use what we build)Paid Time Off—rest and recharge time is non-negotiableMental health support, retirement planning, and financial protectionProfessional development with clear career progression and learning budgetsMission-driven culture where diverse perspectives drive real impact on people's health