[Hiring] Case Manager I - RN @Clever Care Health Plan

Role Description

The Case Manager I – RN is responsible for managing a defined caseload of members. Under general supervision, the Case Manager I conducts assessments, develops care plans, and coordinates services to promote quality outcomes and continuity of care.

Functions & Job Responsibilities

• Conducts comprehensive assessments within regulatory timelines.
• Identifies members appropriate for case management using established criteria and clinical guidance.
• Develops and implements individualized care plans in collaboration with the member, caregiver, and interdisciplinary team.
• Performs telephonic and virtual outreach; face-to-face visits as required.
• Monitors care plan progress and documents interventions timely and accurately.
• Coordinates medical, behavioral health, and community-based services.
• Provides clinical education and self-management coaching.
• Addresses barriers to care including transportation, medication access, and social determinants.
• Serves as primary Transitions of Care (TOC) lead for assigned caseload.
• Escalates high-risk or complex cases to senior staff as appropriate.
• Maintains assigned caseload and meets productivity and compliance standards.
• Participates in team meetings and interdisciplinary care team meetings.
• Additional duties as assigned.

Qualifications

• Active, unrestricted California RN license required.
• 1+ years of experience in case management, managed care, or clinical setting.
• Critical thinking and problem-solving skills.
• Strong work ethic and overall positive attitude.
• Effective communication skills including verbal and written.
• Ability to manage time effectively, understand directions, and work independently in a fast-paced environment.
• Demonstrated flexibility, organization, and self-motivation.
• Highly adaptable to change.
• Bilingual in Mandarin/Cantonese, Vietnamese, Spanish, or Korean, preferred.

Requirements

• Must be able to travel when needed or required.
• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking).
• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.
• Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.
• Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.

Benefits

• Salary range: $70,910.00 - $94,845.00 per year.

Company Description

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.