Case Manager, RN - CA

Job Summary and Responsibilities

Acentra Health is looking for a Nurse Case Manager to join our growing team now!

Job Summary:

The Nurse Case Manager will evaluate beneficiaries' needs, develop individualized care plans, and coordinates healthcare team members to ensure optimal client outcomes while adhering to payer requirements. They also facilitate integrated case and disease management activities based on CMSA principles, aiming to stabilize beneficiaries' health and avoid long-term care placement.

**Position is remote, but candidates must reside in California, preferably in Los Angeles or San Diego area. **

Responsibilities:

• Assess, plan, implement, monitor, and evaluate options and services to affect an appropriate, individualized plan with the beneficiary across the continuum of care.
• Utilize clinical knowledge and competence, communication skills, problem-solving, and conflict resolution to ensure optimal beneficiary outcomes with consideration to client requirements effectively.
• Develop beneficiary-centered care plans.
• Demonstrate shared accountability between beneficiaries, caregivers, and providers.
• Work collaboratively with the beneficiary, provider, and other Health Care team members to coordinate care.
• Address identified gaps in care or compliance.
• Maintain strict standards for client confidentiality and client-related information.
• Comply with all organizational, state, and federal regulations and policies on confidentiality.
• Manage caseload to ensure all required documentation and entry of assessment results into the web-based database are completed accurately and timely, following regulatory requirements and company policies and procedures.
• Maintain open communication with all appropriate parties.
• Pursue ongoing education, certification, and self-development to remain current with case management standards.
• Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules
• This position primarily involves working at a desk and using a computer for extended periods of time
• Other duties as assigned

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

Required Qualifications

• Bachelor's degree/BSN.
• Active, unrestricted RN (Register Nurse) license in CA
• A minimum of 3+ years of clinical experience.
• A minimum of 1+ years of case management review experience.
• Must reside in the state of CA
• Successful communication (written/verbal), with a strong focus on customer service, including building and maintaining relationships with internal/external customers.
• Ability to work independently and as part of a team.
• Maintain a high level of confidentiality.
• Ability to maintain metrics and goals within the department.

Preferred Qualifications

• Bilingual in Spanish
• Ability to assist members and conduct outreach to members without prior engagement.
• Strong cultural competency and the ability to work effectively with diverse populations.
• Flexibility and strong organizational skills.
• Ability to multi-task and prioritize with variable and sometimes conflicting deadlines; superior attention to detail and demonstrated ability in decision-making.

• Maintain professionalism, flexibility, and dependability under pressure.
• Ability to research/identify and apply appropriate standards of care.
• Interest in continuous learning and a commitment to staying informed on regulatory changes.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Experience in Lieu of Degree

For non-clinical roles, or when not required by the contract specifically, the Company acknowledges that practical, hands-on experience can provide skills and competencies equivalent to formal education. As such, in cases where a Bachelor's degree may be required, the Company will accept a minimum of six (6) years of directly relevant professional experience in lieu of a degree. In instances where the candidate has an Associate's degree, the Company will accept a minimum of three (3) years of directly relevant professional experience in lieu of the Bachelor's degree.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

We are committed to providing a secure and positive hiring experience. Depending on the role, interviews may be conducted virtually, in person, or through a combination of both. As part of our recruitment process, candidates may be asked to participate in identity verification measures to help ensure the integrity of the hiring process.

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Pay Range

USD $67,300.00 - USD $110,000.00 /Yr.