Registered Nurse, Case Manager - 257695

Are you a Registered Nurse passionate about whole-person care coordination? Our client is looking for an experienced RN Case Manager to advocate for our members and ensure they receive comprehensive, coordinated support across the healthcare and social services continuum.

In this role, you will assess medical and psychosocial needs, develop individualized care plans, and collaborate with PCPs, specialists, and community partners to help members achieve optimal independence and quality of life.

Work Schedule & Location

• Schedule: Monday – Friday, 8:30 AM – 5:00 PM
• Format: Hybrid (3 days on-site / 2 days remote)
• Location: San Jose, CA
• 6 month contract

Key Responsibilities

• Comprehensive Assessments: Conduct initial and ongoing clinical/psychosocial assessments (telephonic and in-person) evaluating physical, safety, environmental, and cultural needs.
• Care Planning: Partner with members and families to establish member-centric, prioritized care goals.
• Care Coordination: Collaborate with PCPs, specialists, behavioral health, and LTSS providers to support functional independence in community settings.
• Transitions of Care: Facilitate seamless transitions between care settings, assisting with appointments, pharmacy support, and utilization review.
• Documentation & Compliance: Maintain audit-ready case files adhering to state, federal, and organizational standards.

Required Qualifications

• Active, unrestricted California RN license.
• 3+ years of experience in Case Management, Discharge Planning, or equivalent clinical experience.
• Strong background in managed care principles, specifically Utilization Management (UM) and/or Case Management (CM).
• Proven clinical assessment and critical thinking skills for whole-person care planning.
• Proficiency with MS Office (Word, Excel, Outlook) and digital Case Management platforms.

Preferred Qualifications

• Experience with designated populations (Seniors & Persons with Disabilities, Behavioral Health, Children).
• Bilingual fluency in Spanish, Vietnamese, Chinese, or Tagalog.