Case Management Nurse

Medical Professionals is seeking an experienced RN Case Manager to provide comprehensive medical and psychosocial case management services for health plan members. This role serves as a member advocate, coordinating care across interdisciplinary teams to ensure quality outcomes, continuity of care, and compliance with regulatory requirements. The ideal candidate will have strong clinical assessment skills, experience in care coordination, and a passion for improving member health outcomes.

Key Responsibilities

• Conduct comprehensive clinical and psychosocial assessments and ongoing member evaluations
• Develop, implement, and monitor individualized care plans in collaboration with members and their families
• Maintain accurate, timely, and compliant case documentation in accordance with state and federal regulations
• Coordinate care with primary care providers, specialists, behavioral health providers, and community resources
• Facilitate communication among interdisciplinary teams, healthcare providers, vendors, and community agencies
• Support transitions of care, including appointment coordination, pharmacy support, and utilization review activities
• Conduct telephonic and in-person assessments in homes, facilities, and community-based settings as needed
• Participate in quality improvement initiatives, member satisfaction efforts, and care management program activities
• Attend required meetings, trainings, and off-site sessions as assigned
• Support specialized programs including MLTSS and CBAS services when applicable

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Minimum Qualifications

• Active, unrestricted California Registered Nurse (RN) License
• Minimum 3 years of experience in case management, discharge planning, or a related clinical role
• Strong knowledge of managed care, utilization management, and case management principles
• Experience working within interdisciplinary healthcare teams
• Ability to conduct home and community-based visits
• Valid California driver's license with acceptable driving record or reliable alternative transportation
• Proficiency with Microsoft Outlook, Word, Excel, and case management systems
• Strong verbal and written communication skills
• Ability to prioritize multiple responsibilities and meet documentation and regulatory requirements
• Commitment to professionalism, confidentiality, and member safety

Preferred Qualifications

• Bilingual in Spanish, Vietnamese, Chinese, or Tagalog
• Experience working with behavioral health populations
• Experience supporting seniors, individuals with disabilities, or pediatric populations

Schedule and Compensation

• Monday–Friday, 8:00 AM – 5:00 PM PST
• Onsite position in San Jose, California
• 6-Month Contract Assignment
• Pay Range: $50.00 - $68.00 per hour (Depending on Experience)