Telephonic RN Case Manager - Chronic Special Needs Plan (C-SNP)
Location: Fully Remote (Must reside in the U.S. and hold an active California RN License)
Schedule: Monday - Friday, 8:00 AM - 5:00 PM PST (Fixed shift; 1-hour lunch break)
Compensation: $48.08 - $50.48 / hour
Position Overview
We are seeking a compassionate, detail-oriented Registered Nurse to join our care team as a Telephonic RN Case Manager. In this fully remote role, you will manage high-volume, high-touch telephonic outreach for medically complex and chronically ill seniors enrolled in our Special Needs Plan (C-SNP).
Operating from a HIPAA-compliant home office, you will conduct full clinical assessments, establish individualized care plans, deliver disease-state education, and collaborate with Interdisciplinary Care Teams (ICT) to close care gaps and resolve access barriers.
Key Responsibilities
• Telephonic Case Management: Conduct 30-40 calls daily (~3-4 hours of daily phone time; ~80% outbound task queue, ~20% inbound) to coordinate care for chronically ill members.
• Assessments & Care Planning: Execute comprehensive health assessments, establish tailored care plans, and maintain real-time clinical documentation in the AVA care plan system.
• Interdisciplinary Collaboration: Present complex cases during ICT/IDT meetings alongside Nurse Practitioners, Regional Medical Officers (RMOs), and Social Workers.
• Clinical Education: Educate members and caregivers on medication adherence, lab results, and chronic disease management (e.g., CHF, Diabetes/A1C control).
• Care Delegation: Resolve service and access barriers while delegating non-clinical tasks (appointments, transportation, social referrals) to Care Coordinators.
Position Qualifications
Minimum Requirements
• Licensure: Active, unrestricted California Registered Nurse (RN) license (Non-Compact).
• Experience: 1+ years of dedicated Case Management experience and 2+ years of clinical nursing experience.
• Languages: Fully fluent / bilingual in Spanish (written and verbal).
• Multi-State Licensing: Willingness to obtain additional RN licenses in NV, AZ, NC, and TX post-hire (100% company-reimbursed).
• Technical Skills: Proficiency in Microsoft Office (Word, Excel, Outlook, Teams) and aptitude for manual note-taking within care management systems.
• Workspace: Dedicated, quiet, and secure HIPAA-compliant home workspace with reliable high-speed internet.
Preferred Qualifications
• Education: Bachelor of Science in Nursing (BSN).
• Industry Background: Prior experience in Medicare Advantage, Medicaid, Dual-Eligible Special Needs Plans (D-SNP), or IPA/Health Plan environments.
• Additional Languages: Fluency in Vietnamese, Korean, or Mandarin.
Key Competencies
• Excellent verbal communication and active listening skills over the phone.
• Strong self-motivation and time management to handle structured, high-volume call workflows.
• Ability to interpret clinical data (labs, blood work, medications) and communicate concepts clearly to patients.
For California Applicants:
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.