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Registered Nurse Care Manager (RNCM)
Position Overview
Heritage Health Network (HHN) is seeking a Registered Nurse Care Manager (RNCM) to provide clinical oversight and guidance to a team of non-clinical Lead Care Managers within our Enhanced Care Management (ECM) program.
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
- Lead Care Managers
- 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.
Requirements
Qualifications
- 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
Benefits
- Medical, dental, and vision insurance
- Paid time off + holidays
- Quarterly bonuses
- Hybrid flexibility
- Growth and development opportunities
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