RN Clinical Case Manager

Position Summary

The RN Clinical Care Manager (CCM) serves as a trusted partner and advocate for members, providing compassionate, coordinated, and person-centered care within the Enhanced Care Management (ECM) program. This role combines the relational and member-engagement strengths of the Lead Care Manager with the clinical expertise and system coordination responsibilities of an RN Case Manager.

Under the general supervision of Enhanced Care Management Leadership, the RN Clinical Care Manager develops and implements personalized care plans, conducts comprehensive assessments, facilitates care transitions, and builds strong, trusting relationships with each member. Through collaboration with Primary Care Providers (PCPs), interdisciplinary care teams, and community partners, the CCM ensures that members receive the right care, at the right time, in the right place—supporting improved outcomes and health equity for diverse Medi-Cal populations.

Key Responsibilities

Member Engagement and Relationship Building

• Visit members in-person and virtually to conduct initial and ongoing assessments of medical, behavioral, and social needs.
• Build rapport with members and families, fostering trust and empathy to support long-term engagement and self-sufficiency in health.
• Provide compassionate emotional support, active listening, and culturally sensitive coaching to empower members in their care journey.
• Respond promptly and professionally to member inquiries, concerns, and care needs, ensuring service adherence to legal and payer guidelines.

Care Coordination and Clinical Oversight

• Develop and maintain individualized, whole-person care plans based on comprehensive assessments addressing physical health, behavioral health, substance use, long-term care, housing, and social service needs.
• Work collaboratively across the healthcare continuum—primary care, specialists, hospitals, behavioral health, and community agencies—to integrate medical and social support.
• Monitor member progress and outcomes, adjust care plans as needed, and ensure regular follow-up through telehealth and in-person interactions.
• Facilitate safe and effective care transitions, including discharge planning, follow-up appointments, and home-based care coordination.
• Advocate for timely access to appropriate treatments, medications, and support services.

Clinical Leadership and Quality Improvement

• Review utilization patterns of high-risk patients and work with healthcare teams to design interventions that reduce avoidable hospital and ED visits.
• Analyze payer and quality performance reports to identify care gaps and implement improvement strategies.
• Participate in developing and training team members on quality improvement, safety, and case management best practices.
• Maintain compliance with Medi-Cal, HEDIS, and quality standards while advancing health equity across all populations.

Population Management

Manage a caseload of members within ECM's populations of focus, including but not limited to:

• Individuals experiencing homelessness
• Those with serious mental illness and/or substance use disorders
• Individuals transitioning from incarceration
• High utilizers of emergency services
• Adults at risk of institutionalization or transitioning from nursing facilities
• Pregnant/postpartum individuals facing racial or ethnic birth inequities
• Children and youth in child welfare or California Children's Services (CCS)

Qualifications

Required

• Current California RN license in good standing.
• 2–3 years of clinical experience in case management, acute care, ICU/CCU, or home health.
• Strong understanding of Medi-Cal, care coordination, and social determinants of health.
• Excellent analytical, clinical judgment, interpersonal, and communication skills.
• Proficiency in MS Office (Excel, Word, Outlook) and electronic health record systems.
• Valid California driver's license, car insurance, and access to a reliable vehicle.
• Ability to travel locally for member visits; mileage reimbursement provided.
• Compassionate, nonjudgmental, and culturally sensitive approach.

Preferred

• Bachelor's or Associate degree in Nursing, Healthcare Administration, or a related field.
• Bilingual, Spanish.
• Certified Case Manager (CCM) or equivalent certification.
• Experience in Managed Care, Community Health, or Behavioral Health settings.
• Certification or experience using Motivational Interviewing or empathy-based communication strategies.
• Familiarity with regional health disparities and principles of self-management support for chronic conditions.

Physical and Work Requirements

• Prolonged periods sitting at a desk or driving for community visits.
• Frequent computer usage; must be able to lift up to 10 pounds.
• Occasional evening or weekend work within a 40-hour week.

This position provides a unique opportunity to combine clinical expertise with compassionate engagement in the community—empowering members to achieve their health goals through trust, advocacy, and coordinated, person-centered care.