Registered Nurse Care Manager (RNCM)

This is a remote position.

Requirements

• Clinical Oversight & Quality Assurance
  
• • Review member charts in the EMR system to assess care plans, medical history, and treatment adherence.
    
  • Ensure the quality and appropriateness of care coordination for members in the ECM program.
    
  • Provide clinical guidance to non-clinical Lead Care Managers, helping them navigate complex cases.
    
  • Identify gaps in care and recommend interventions to improve health outcomes.
    
• Care Coordination & Collaboration
  
• • Work closely with a multidisciplinary team that includes:
    
  • • Lead Care Managers
      
    • Behavioral Health Care Managers
      
    • Community Health Workers
      
• Partner with healthcare providers and community organizations to facilitate referrals and-access to care.
  
• Participate in weekly team case reviews to discuss high-risk members and ensure best practices in care management.
  
• Support care transitions by coordinating with hospitals and providers to optimize
  discharge planning.
  
• Regulatory Compliance & Documentation
  
• • Ensure compliance with Medi-Cal ECM guidelines and other healthcare regulations.
    
  • Maintain accurate documentation in the electronic health record (EHR) system.
    
  • Provide clinical input for monthly reports required by health plans and regulatory bodies.
    

• License: Active Registered Nurse (RN) license in California.
  
• Experience:
  
• • Minimum 2 years of nursing experience, with at least 1 year in care management, case management, or leadership.
    
  • Experience working with vulnerable populations and individuals with complex medical and social needs.
    
  • Familiarity with Enhanced Care Management (ECM) or similar care coordination
    programs are preferred.
    
• Skills & Knowledge:
  
• • Strong clinical assessment and care planning skills.
    
  • Knowledge of Medi-Cal, Medicare, and care management best practices.
    
  • Excellent communication and teamwork abilities.
    
  • Proficiency in electronic medical records (EMR) systems.