[Hiring] Senior Care Integration Registered Nurse @Medix

Role Description

A leading regional Medi-Cal managed care plan is seeking a detail-oriented Senior Care Integration Registered Nurse (RN) for a full-time, temporary remote position scheduled through December 2026, with potential extension into 2027 based on business needs. In this role, you will perform quality and oversight record reviews for Enhanced Care Management (ECM) program providers, ensuring non-duplicative, high-quality care across the provider network.

Key Responsibilities

• Perform clinical quality reviews and audit provider charts (target minimum: 20 charts per day).
• Evaluate Enhanced Care Management (ECM), Community Supports (CS), and Transitions of Care (TOC) service delivery to ensure compliance and care integrity.
• Provide written audit feedback and clear communications to external ECM providers detailing findings and areas for improvement.
• Coordinate across internal departments, external providers, and community agencies to streamline care continuum transitions.
• Assist with program oversight, compliance reporting, and provider training initiatives.

Qualifications

• Active, unrestricted Registered Nurse (RN) license issued by the State of California.
• Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN).
• 5+ years of overall RN experience with at least 3+ years in Case Management.
• Strong clinical judgment, record review skills, and high attention to detail.
• Excellent written communication skills for formal audit correspondence.

Preferred Qualifications

• 5+ years of dedicated Case Management experience.
• Bachelor of Science in Nursing (BSN).
• National Case Management Certification (e.g., CCM).
• Background in public health, community health, home health, or population health.
• Bilingual skills (English/Spanish or English/Hmong).

Work Environment & Details

• Schedule: Monday - Friday, 8:00 AM - 5:00 PM PST.
• Location: 100% Remote (Must reside in California).
• Equipment: Full IT setup (laptop, monitor, headset) provided.

Pay Range

• Zone 1 (Santa Cruz, San Benito, Monterey, Bay Area, Sacramento, Los Angeles, San Diego): $49.00 - $63.00/hr
• Zone 2 (Mariposa, Merced, Fresno, Bakersfield, Central Valley, SLO): $46.00 - $59.00/hr

Background Check Information

As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as minors, elderly and those with physical or mental disabilities.