[Hiring] Bilingual RN Case Manager @Alignment Health

Role Description

The Remote RN Case Manager SNP (must have RN License in California [Non-Compact]) is responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs. Delivers care to members utilizing the nursing process and effectively interacts with members, caregivers, and other interdisciplinary team participants. Assists with closing gaps in care and resolving barriers that prevent members from attaining improved health. Reaches out and connects with members via the telephone.

Schedule: Must be willing to work 8:00am - 5:00pm Pacific Time

General Duties / Responsibilities

• Coordinates care by serving as a resource for the member, their family, and their physician.
• Ensures access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.
• Completes 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.
• Provides 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.

Qualifications

• Minimum 2 years' clinical experience.
• Minimum 1 year case management experience.
• Health Plan experience preferred.
• Successfully passing Post High School courses to obtain an RN licensure or AS in Nursing.
• BSN or Bachelor's preferred.

Requirements

• 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 establish and maintain a constructive relationship with diverse members, management, employees, and vendors.
• 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.
• Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly.
• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement, and manage appropriate resolution.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Comprehend and analyze statistical reports.

Benefits

• Pay Range: $77,905.00 - $116,858.00
• Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.