Remote Bilingual Telephonic RN Case Manager - Outpatient (Must have California License)

Job Number: 7580

Workplace Type: Fully Remote

Position Title: Case Manager

External Description:

Overview of the Role:

Alignment Health is seeking an organized, compassionate, and tech savvy bilingual Spanish telephonic RN case manager (Must have California License) to join the remote case management team. As an RN Case manager, you are responsible for health care management and coordination, within the scope of licensure, for Alignment Health members with complex and chronic care needs.  You get to deliver care to members utilizing the nursing process and interacts with Alignment Health members, care givers, and other interdisciplinary team members. You will also assist with closing gaps in care and resolving barriers that prevent members from attaining improved health. 

If you are seeking an opportunity to learn and grow, join a team that is positively impacting the loves of seniors, and be a part of an organization that is continuing to expand – we are 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

Responsibilities:

• Coordinate care by serving as a resource for members’, their family, and their physician.
• Ensure access to appropriate care for members with urgent or immediate needs facilitating referrals / authorizations within the benefit structure as appropriate.
• Complete comprehensive assessments within their scope of practice that includes assessing the members’ current health status, resource utilization, past and present treatment plan, and services.
• Collaborate with the member, the primary care physician (PCP) and other care team members to implement a plan of care. 
• Interface with primary care physicians (PCP), hospitalists, nurse practitioners (NP), and specialists on the development of care management treatment plans.
• Provide education and self-management support based on members’ unique learning style.
• Assist in problem solving with providers, claims, or service issues.
• Work closely with delegated or contracted providers, groups, or entities to assure effective and efficient care coordination.
• Maintain confidentiality of all protected health information (PHI) in compliance with state and federal law and Alignment Health policy.

Required Skills and Experience:

• Minimum (2) years’ clinical experience ; or any combination of education and experience, which would provide an equivalent background.
• Minimum (2) years of 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.
• Possess high level of understanding of community resources, treatment options, home health, funding options, and special programs
• Extensive knowledge of the management of chronic conditions
• Bilingual English and Spanish highly preferred (Also willing to consider bilingual Vietnamese or Chinese)
• Excellent written and verbal communications skills
• Team player who builds effective working relationships
• Able to work independently
• Experience using standardized clinical guidelines required
• Strong organizational skills
• Proficient in Microsoft Office (Outlook Word, Excel, PowerPoint, etc.)

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear.
2. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
3. The employee frequently lifts and / or moves up to 10 pounds.
4. Specific vision abilities required by this job include close vision and the ability to adjust focus.

PAY RANGE: $79,900.00-$100,000.00 annually

City: Remote-US

State: California

Location City: Remote-US

Location State: California

Community / Marketing Title: Remote Bilingual Telephonic RN Case Manager - Outpatient (Must have California License)

Company Profile:

Alignment Health is revolutionizing health care for seniors by leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].