Care Manager, RN

Role Overview

• Exercise independent clinical judgment and strategic planning in managing a caseload of members with complex medical and behavioral health needs according to department processes and duties.
• Recommend care coordination strategies for members, including but not limited to, the following: Apply brief medical/behavioral interventions and evidence-based methodologies as necessary to enhance the member’s ability to manage their own health.
• Lead the development of individualized care plans (ICPs) or discharge plans through comprehensive biopsychosocial assessments and interdisciplinary collaboration.
• Develop and communicate ICP with the member, approved family or caregiver and other members of the care team.
• Facilitate and guide interdisciplinary care team meetings, influencing care plan modifications and alignment with member goals.
• Review and revise contributions to assessment information and care planning from care team members (i.e. LVN Care Manager, Care Coordinator) as appropriate.
• Initiate and oversee quality improvement initiatives and projects that address clinical gaps (e.g., HEDIS measures), improve health outcomes, and support innovation.
• Identify, develop, and test new practices for improving member health outcomes.
• Advocate for timely, high-quality care for members by coordinating with internal partners and external providers across the continuum of services.
• Utilize clinical tools and metrics (e.g., PHQ scores, ER visit trends, hospitalization trends, substance use trends) to inform interventions, manage caseloads, and escalate high-risk cases appropriately.
• Design transitional care strategies for members shifting between care settings, ensuring coordination of services such as home health, DME, and primary care follow-up.
• Implement targeted outreach approaches to support care continuity, promote resource linkage, and empower member self-efficacy across care transitions.
• Cultivate and sustain productive partnerships with providers, team members, and community stakeholders.
• Employ advanced communication methods to strengthen collaboration across in-person, telephonic, and digital platforms.
• Ensure clinical documentation adheres to all applicable state, federal, and accreditation standards.
• Drive audit readiness and reporting integrity through proactive compliance oversight.
• Serve as a subject matter resource by providing formal and informal education to peers and cross-functional staff on medical conditions, treatment protocols, and emerging evidence in behavioral/medical health care.
• Participate in staff meetings, trainings, cross-functional committees, department planning initiatives, and professional conferences to represent Medical and Behavioral Health perspectives and contribute to strategic alignment with organizational goals.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Requirements

• Minimum two (2) years clinical experience in an acute care facility, skilled nursing facility, home health or clinic setting required
• Two (2) or more years of care management experience in a health care delivery setting preferred
• Experience in a Managed Care (HMO, IPA) or in acute facility (i.e. hospital) care management preferred
• Associate’s degree in Nursing from an accredited institution required
• Bachelor’s degree in Nursing from an accredited institution preferred
• Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN required
• Knowledgeable and skilled in evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies
• Understanding of and sensitivity to multi-cultural community
• Deep understanding and knowledge of self-management philosophies and practices, especially as they relate to chronic medical conditions
• Awareness of the impact of unmitigated bias and judgement on health; commitment to addressing both
• Must have knowledge of whole health and integrated principles and practices
• Bilingual (English/Spanish) preferred
• Highly skilled in interpersonal communication, including conflict resolution
• Effective written and oral communication skills, as well as reasoning and problem-solving skills
• Skillful in informally and formally sharing expertise

Benefits

• Competitive salary
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance