Alignment Health is seeking an organized, compassionate, and tech savvy bilingual Spanish telephonic RN case manager (Must have California License) to join the remote case management team. As an RN Case manager, you are responsible for health care management and coordination, within the scope of licensure, for Alignment Health members with complex and chronic care needs. You get to deliver care to members utilizing the nursing process and interacts with Alignment Health members, care givers, and other interdisciplinary team members. You will also assist with closing gaps in care and resolving barriers that prevent members from attaining improved health.
If you are seeking an opportunity to learn and grow, join a team that is positively impacting the loves of seniors, and be a part of an organization that is continuing to expand - we are 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 members', 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 members' current health status, resource utilization, past and present treatment plan, and services.
Collaborate with the member, the primary care physician (PCP) and other care team members to implement a plan of care.
Interface with primary care physicians (PCP), hospitalists, nurse practitioners (NP), and specialists on the development of care management treatment plans.
Provide education and self-management support based on members' unique learning style.
Assist in problem solving with providers, claims, or service issues.
Work closely with delegated or contracted providers, groups, or entities to assure effective and efficient care coordination.
Maintain confidentiality of all protected health information (PHI) in compliance with state and federal law and Alignment Health policy.
Required Skills and Experience:
Minimum (2) years' clinical experience ; or any combination of education and experience, which would provide an equivalent background.
Minimum (2) years of 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.
Possess 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 highly preferred
Excellent written and verbal communications skills
Team player who builds effective working relationships
Able to work independently
Experience using standardized clinical guidelines required
Strong organizational skills
Proficient in Microsoft Office (Outlook Word, Excel, PowerPoint, etc.)
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear.
The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and / or moves up to 10 pounds.
Specific vision abilities required by this job include close vision and the ability to adjust focus.
