[Hiring] Registered Nurse Care Manager @Heritage Health Network

This is a remote position.

We are seeking a Registered Nurse Care Manager (RNCM) to provide clinical oversight for a team of non clinical Lead Care Managers. In this fully remote role, you will review member charts in the electronic medical record (EMR) system, assess care plans, and collaborate with Lead Care Managers to ensure members receive comprehensive, high-quality clinical care.

Most hours can be completed at your convenience. However, one hour per week will be required to participate in case reviews with the ECM team.

Requirements

Key Responsibilities

• Clinical Oversight & Quality Assurance
  
• Review member charts in the EMR system to assess care plans, medical history, and treatment adherence.
  
• Ensure the quality and appropriateness of care coordination for members in the ECM program.
  
• Provide clinical guidance to non-clinical Lead Care Managers, helping them navigate complex cases.
  
• Identify gaps in care and recommend interventions to improve health outcomes.
  
• Care Coordination & Collaboration
  
• Work closely with a multidisciplinary team that includes:
  
• Lead Care Managers
  
• Behavioral Health Care Managers
  
• Community Health Workers
  
• Partner with healthcare providers and community organizations to facilitate referrals and-access to care.
  
• Participate in weekly team case reviews to discuss high-risk members and ensure best practices in care management.
  
• Support care transitions by coordinating with hospitals and providers to optimize
  discharge planning.
  
• Regulatory Compliance & Documentation
  
• Ensure compliance with Medi-Cal ECM guidelines and other healthcare regulations.
  
• Maintain accurate documentation in the electronic health record (EHR) system.
  
• Provide clinical input for monthly reports required by health plans and regulatory bodies.
  

Qualifications

• Licensure: Active Registered Nurse (RN) license in California.
  
• Experience:
  
• Minimum 2 years of nursing experience, with at least 1 year in care management, case management, or leadership.
  
• Experience working with vulnerable populations and individuals with complex medical and social needs.
  
• Familiarity with Enhanced Care Management (ECM) or similar care coordination
  programs is preferred.
  
• Skills & Knowledge:
  
• Strong clinical assessment and care planning skills.
  
• Knowledge of Medi-Cal, Medicare, and care management best practices.
  
• Excellent communication and teamwork abilities.
  
• Proficiency in electronic medical records (EMR) systems.