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Remote RN Case Manager, Outpatient (Must have California RN License)

Location: Remote-US, California US

Job Number6401

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 thats 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, telephonic, RN case manager to join the outpatient case management team. As an RN case manager, you will be responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs. You will also deliver care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants. Thecase manager will assist with closing gaps in care and resolving barriers that prevent members from attaining improved health. The Case Manager will connect with members telephonically.

Responsibilities:

• Coordinate care by serving as a resource for the member, their family and their physician.
• Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate.
• Complete 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.
• Provide education and self-management support based on the members 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.

Required Skills and Experience:

• Minimum 1-3 years’ clinical experience,
• Minimum 2 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 inCalifornia
• 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
• Bilingual English and Spanish, Chinese, or Vietnamese preferred
• Excellent verbal and written communications skills
• Team player who builds effective working relationships
• Able to work independently
• Experience using standardized clinical guidelines required
• Strong organizational skills
• Strong proficiency in Microsoft Office suite (Word, Excel, PowerPoint, etc.)

Pay range: $78,000 – $118,000 annually.

Please note: All clinical positions are contingent upon successful engagement with Alignment Healths 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 iniduals 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 athttps://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Healths talent acquisition team, please [email protected].