Remote RN Case Manager, SNP (Must Have California RN License) at Alignment Healthcare USA, LLC in Orange, California

Job Description:

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

• 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.

• 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.)