CA Licensed Nurse Care Manager, Adult

We're looking for Nurse Care Managers for our Care and Case Management team, who hold a UT Compact RN license and also a CA RN license; have experience working with a health plan, health navigator or third-party administrator (TPA). Are passionate about caring for members holistically through their healthcare journey and ensuring needs are met with industry-leading interventions. As a telephonic Nurse Care Manager you will report to the Manager, Care and Case Management and will guide members through complex medical and behavioral Health situations, partnering with a diverse clinical team that includes a variety of healthcare professionals, care coordinators, and records specialists, to deliver integrated remote care in a creative way. The Nurse Care Manager should enjoy spending time on the phone, listening to members' needs, answering questions, and serving as an advocate. You will excel at creating cohesive care plans, and have the clinical skills to guide members clinically and navigate available benefits and resources. Nurse Care Managers will support members through complex care management, disease management, and acute case management, ensuring they receive longitudinal care that results in excellent health outcomes.#LI-Remote

Responsibilities:

• Deliver coordinated, patient-centered virtual Care Management by telephone or video that improves members' health outcomes.
• Create impactful care plans together with members and our diverse care team, and help members achieve the desired goals.
• Help members navigate complex medical conditions, treatment pathways, benefits, and the healthcare system in general.
• Partner with the members' local providers to ensure coordinated care.
• Provide compassionate, longitudinal follow-up care, building supportive relationships.
• Assist throughout acute healthcare episodes, such as hospitalizations and rehabilitation stays, providing coordinated Case Management to support the member and their family.
• Coordinate necessary resources that holistically address members' problems, whether clinical or social

Qualifications:

• Bachelor of Science in Nursing (BSN).
• Must have current CCM Certification or eligibility for exam in August 2025
• 5+ years of experience in nursing
• 2+ years experience working in care management
• Must reside in a compact NLC state.
• Active Compact RN license in good standing with the nursing board of their state.
• Active California Nursing License
• Willingness to become (and maintain) licensure in multiple states.
• Work until 6pm PST (Preference for those based in MST/PST time zones)
• Be comfortable discussing several medical conditions and experience with populations across the age ranges
• Spanish speaking desirable
• Experience working remotely, and strong competence and ability to use multiple computer/medical record systems.
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