Care Managment RN

Description

JOB SUMMARY

The Care Management RN provides clinical care management services to assigned patients, with a focus on coordinating care, supporting transitions, addressing barriers, and promoting appropriate utilization of healthcare resources. The RN conducts clinical case reviews, develops and updates individualized care plans, performs patient outreach and follow-up, and collaborates with providers and interdisciplinary teams to support quality outcomes, continuity of care, and patient satisfaction. The role performs duties in accordance with established department procedures, clinical criteria, health plan requirements, and applicable regulatory standards.

Requirements

MINIMUM & PREFERRED QUALIFICATIONS

Education/Training

Minimum: High school diploma or equivalent. Graduate of an accredited Registered Nursing Program.

Preferred: Bachelor’s degree in Nursing or related healthcare field.

Experience 

Minimum: 2+ years of Registered Nursing experience in care management, utilization management/review, ambulatory care, or a related managed care or healthcare setting.

Preferred: Previous ambulatory care management, case management, or managed care experience.

Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Certification(s)

Active, unrestricted California Registered Nurse (RN) license

Skills, Knowledge & Abilities

· Strong knowledge of care management principles, managed care, and healthcare delivery systems.

· Ability to type 40 words per minute with accuracy.

· Proficient in Microsoft Office (Word, Excel, Outlook, Access, PowerPoint).

· Excellent written and verbal communication skills.

· Ability to assess and analyze clinical information, apply established criteria, identify barriers to care, and support program compliance.

· Strong organizational skills and the ability to manage multiple priorities.

· Ability to work independently and collaboratively within an interdisciplinary, patient-centered environment.

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. The Care Management RN role requires the ability to perform work in a standard office and clinical support environment. The position involves prolonged periods of sitting for documentation, telephone communication, and computer use, with occasional standing, walking, and driving between facilities. The role requires light physical effort, including lifting up to 20 pounds, occasional bending, stooping, squatting, reaching, and frequent stair climbing. The position also demands sustained attention to detail, the ability to manage multiple priorities, and effective communication with providers, patients, caregivers, and interdisciplinary team members. The work environment may involve interacting with clinical settings during facility visits and participating in emergency response situations as appropriate.

PAY RANGE

$85,000.00 - $100,000.00 / annually