Registered Nurse Care Manager (RNCM)
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Job Location:
Monthly Salary:
Experience Required:
Posted on:
4 days ago
Vacancies:
1 Vacancy
Job Summary
This is a remote position.
We are seeking a Registered Nurse Care Manager (RNCM) to provide clinical oversight for a team of non clinical Lead Care this fully remote role you will review member charts in the electronic medical record (EMR) system assess care plans and collaborate with Lead Care Managers to ensure members receive comprehensive high-quality clinical care.
Most hours can be completed at your convenience. However one hour per week will be required to participate in case reviews with the ECM team.
Requirements
Key Responsibilities
- 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.
Qualifications
- Licensure: 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 is 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.
Required Skills:
Qualifications: A combination of relevant experience and/or education (open to both). Previous experience in medical practice management is required. Strong knowledge of healthcare laws health plan requirements and regulations. Familiarity with Lean and Six Sigma methodologies is a plus. Excellent leadership communication and interpersonal skills. Proven ability to manage budgets and optimize revenue generation. Strong analytical and problem-solving skills. Project Management Experience is a plus
Required Education:
RN License
Company Industry
IT Services and IT Consulting
Key Skills
- EMR Systems
- Hospital Experience
- Acute Care
- ICU Experience
- Hospice Care
- Workers' Compensation Law
- Home Care
- Nursing
- Catheterization
- Critical Care Experience
- Medication Administration
- Tube Feeding
