Remote RN Case Manager, SNP (Must Have California RN License) – California

Job Overview

  • Clinical License RN
  • State(s) CA

Location: Remote-US, California US

Job Number6839
Workplace Type:Fully Remote
Remote-US,California

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

Overview of the Role:

Alignment Health is seeking a remote RN case manager (must have California RN License) to join the case management, special needs program (SNP) team.  As the RN case manager (SNP), you will be responsible for health care management and coordination within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.  You will connect with patients on the phone. Along with other members of the health team, you will conduct comprehensive assessments that include the medical, behavioral, pharmaceutical and social needs of the patient, identify gaps in care and barriers to attaining improved health. Based on this assessment, and in conjunction with the patient, the patient’s physician and other members of the health team, create and implement a care plan that will address the identified needs, remove the barriers and improve the health of the patient.

If you are hungry for an opportunity to join a growing organization that is committed to impacting the lives of it’s senior members, be a part of a positive and collaborative team, and learn and develop – we’re looking for you!

Schedule: Monday through Friday

  • 8:00am – 5:00pm Pacific Time
  • 9:00am – 6:00pm Mountain Time
  • 10:00am – 7:00pm Central Time
  • 11:00am – 8:00pm Eastern Time

Responsibilities:

  • Coordinate care by serving as a resource for the patient, their family and their physician.
  • Measure, improve, and maintain quality outcomes (clinical, financial, and functional) for individual patients and the population served.
  • Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals / authorizations within the benefit structure as appropriate.
  • Assess the member’s current health status, resource utilization, past and present treatment plan and services; prognosis, short and long term goals, treatment and provider options.
  • Monitor and evaluate effectiveness of the care management plan and modifies as necessary.
  • Interface with primary care physicians (PCP), extensivists, nurse practitioners (NPs), and specialists on the development of care management treatment plans.
  • Provide education and self-management support based on the patient’s unique learning style.
  • Negotiate rates of reimbursement, as applicable.
  • Assist in problem solving with providers, claims or service issues.
  • Measure the effectiveness of interventions to determine case management outcomes.
  • Works closely with delegated or contracted providers, groups or entities (as assigned) to assure effective and efficient care coordination.
  • Maintain confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy.

Requirements:

  • Minimum 1-3 years’ clinical experience
  • Minimum 3-5 years’ case management experience; or any combination of education and experience, which would provide an equivalent background.
  • Health plan experience preferred
  • Must have and maintain an active, valid and unrestricted RN license in California
  • Case management certification preferred
  • 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
  • Excellent verbal and written communications skills
  • Excellent case preparation and abstracting skills
  • Team player who builds effective working relationships
  • Able to work independently
  • Experience using standardized clinical guidelines required
  • Strong organizational skills
  • Strong proficiency with Microsoft Office suite of products (Word, Excel and PowerPoint, etc.)

Pay range: $77,100 – $100,000 Annually

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

 

 

 

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