Job DescriptionRegistered Nurse Care Manager (RNCM)The RNCM will review member charts, assess care plans, identify gaps in care, and provide clinical guidance to ensure members receive comprehensive, high-quality care. The role includes a combination of
remote clinical work and field-based activities, including in-person member and provider engagement as needed.
Clinical Oversight & Quality Assurance- Review member charts in the EMR/EHR to assess care plans, medical history, and treatment adherence.
- Ensure the quality and appropriateness of care coordination for ECM members.
- Provide clinical guidance to non-clinical Lead Care Managers on complex member cases.
- Identify gaps in care and recommend appropriate interventions to improve health outcomes.
Care Coordination & Field Support- Collaborate with a multidisciplinary care team, including:
- Lead Care Managers
- Behavioral Health Care Managers
- Community Health Workers
- Conduct field-based visits and member engagement activities as needed to support care coordination and clinical needs.
- Participate in in-person member assessments, care coordination, and follow-up activities when appropriate.
- Partner with healthcare providers, hospitals, and community organizations to facilitate referrals and access to care.
- Support care transitions by coordinating with hospitals and healthcare providers to optimize discharge planning.
- Participate in weekly case reviews to discuss high-risk members and support best practices in care management.
Regulatory Compliance & Documentation- Ensure care management activities align with Medi-Cal ECM guidelines and applicable healthcare regulations.
- Maintain accurate and timely documentation in the electronic health record (EHR) system.
- Provide clinical input for monthly reports required by health plans and regulatory bodies.
RequirementsQualifications- Active Registered Nurse (RN) license in California.
- Minimum 2 years of nursing experience.
- At least 1 year of experience in care management, case management, or a leadership capacity.
- Experience working with vulnerable populations and individuals with complex medical and social needs.
- Strong clinical assessment and care planning skills.
- Proficiency with electronic medical records (EMR/EHR) systems.
- Excellent communication, collaboration, and clinical judgment skills.
- Ability and willingness to perform field-based work and in-person member engagement as required.
Benefits- Medical, dental, and vision insurance
- Paid time off + paid holidays
- Performance bonuses based on measurable role-specific goals
- Hybrid work flexibility
- Growth and professional development opportunities
- Meaningful work supporting vulnerable Medi-Cal populations
