Case Management Nurse New

About the Company - We are seeking a dedicated Registered Nurse (RN) Case Manager / Care Coordination Team Leader to join our team in an ambulatory clinic setting. Under the general supervision of the Nursing Supervisor and oversight of Clinic Physicians, this role is responsible for managing and coordinating care for all assigned clinic participants, ensuring high-quality, person-centered care.

About the Role - Key Responsibilities:

• Conduct and complete reassessments for assigned participants every 6 months, either in-person at the clinic or during home visits.
• Determine and allocate in-home supportive caregiver hours based on assessments conducted in collaboration with the Interdisciplinary Team (IDT), focusing on Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).
• Maintain accurate and timely documentation of interactions involving participants, family members, caregivers, hospitals, contracted providers, skilled nursing facilities (SNFs), and other facilities involved in the participant's care.

Work Environment - Medical office environment with climate control via central air conditioning. May involve travel to participant homes for assessments.

Required Skills & Abilities:

• Strong customer service skills with the ability to resolve complex issues and manage conflict effectively.
• Clear, professional communication skills (written and verbal), including active listening and knowledge of medical terminology.
• Basic math proficiency and intermediate computer skills, including data entry and electronic documentation.
• Detail-oriented with excellent follow-through and organizational skills.
• Ability to work efficiently in a fast-paced environment, manage multiple tasks, and meet deadlines.
• Culturally competent and comfortable working with diverse populations.
• Familiarity with Managed Care principles, PACE regulations, NCQA, JCAHO, and HEDIS standards.
• Knowledge of HIPAA guidelines and handling of Protected Health Information (PHI).
• Strong health assessment skills, particularly in geriatrics.
• Understanding of preventive care measures for at-risk populations.
• Collaborative mindset with the ability to contribute as part of a multidisciplinary team.

Qualifications:

• Current, valid California RN license
• Minimum 1 year of experience in Geriatric Nursing (required)
• Experience in a managed care setting, preferably in utilization or case management in an ambulatory or inpatient environment (preferred)
• Current BLS/First Aid certification (required)
• Bilingual in English and Spanish (preferred)