Registered Nurse Care Manager

Job Opportunity at Heritage Health NetworkHeritage Health Network (HHN) was born from a vision to bridge the gap in healthcare accessibility, intuitiveness, and responsiveness. Our story is deeply intertwined with the dedication of our founder, a seasoned prosthetist orthotist with over 15 years of experience serving our community. Committed to improving health outcomes, our founder's expertise and deep community ties have been instrumental in shaping HHN's approach and services. The genesis of HHN was fueled by the need to address the unique challenges faced by Black Americans and individuals with limb loss. Our logo, featuring a bridge, symbolizes our commitment to connecting these communities with comprehensive, empathetic healthcare solutions. It represents our role as a crucial link between medical care and the social determinants of health that are vital for holistic well-being. With a foundation in Enhanced Care Management (ECM), HHN has evolved into a holistic, person-centered network. We believe in treating the individual, not just the condition, by considering the full spectrum of their life's context. This approach stems from our founder's deep understanding of the intricacies of patient care, honed through years of hands-on experience. Today, HHN stands as a vibrant embodiment of community-centric healthcare, continually adapting to meet the changing needs of those we serve. Our journey, marked by resilience, innovation, and unwavering dedication, is a testament to our founder's vision of a healthier, more empowered community. We are proud to continue this legacy, forging new paths towards improved health outcomes and a brighter future for all.Areas Covered: Low Desert, Coachella Valley, Palm Springs, IndioJob DescriptionRegistered Nurse Care Manager (RNCM) Position Overview Heritage Health Network (HHN) is seeking a Registered Nurse Care Manager (RNCM) to provide clinical oversight and guidance to a team of non-clinical Lead Care Managers within our Enhanced Care Management (ECM) program. The RNCM will review member charts, assess care plans, identify gaps in care, and provide clinical guidance to ensure members receive comprehensive, high-quality care. The role includes a combination of remote clinical work and field-based activities, including in-person member and provider engagement as needed.Clinical Oversight & Quality AssuranceReview member charts in the EMR/EHR to assess care plans, medical history, and treatment adherence.Ensure the quality and appropriateness of care coordination for ECM members.Provide clinical guidance to non-clinical Lead Care Managers on complex member cases.Identify gaps in care and recommend appropriate interventions to improve health outcomes.Care Coordination & Field SupportCollaborate with a multidisciplinary care team, including: Lead Care Managers, Behavioral Health Care Managers, Community Health Workers.Conduct field-based visits and member engagement activities as needed to support care coordination and clinical needs.Participate in in-person member assessments, care coordination, and follow-up activities when appropriate.Partner with healthcare providers, hospitals, and community organizations to facilitate referrals and access to care.Support care transitions by coordinating with hospitals and healthcare providers to optimize discharge planning.Participate in weekly case reviews to discuss high-risk members and support best practices in care management.Regulatory Compliance & DocumentationEnsure care management activities align with Medi-Cal ECM guidelines and applicable healthcare regulations.Maintain accurate and timely documentation in the electronic health record (EHR) system.Provide clinical input for monthly reports required by health plans and regulatory bodies.RequirementsActive Registered Nurse (RN) license in California.Minimum 2 years of nursing experience.At least 1 year of experience in care management, case management, or a leadership capacity.Experience working with vulnerable populations and individuals with complex medical and social needs.Strong clinical assessment and care planning skills.Proficiency with electronic medical records (EMR/EHR) systems.Excellent communication, collaboration, and clinical judgment skills.Ability and willingness to perform field-based work and in-person member engagement as required.BenefitsHealth Insurance: Eligible for medical, dental, and vision insurance from the first of the month following or coinciding with your start date.Paid Time Off: Sick time, paid holidays, and vacation time to support work-life balance.Compensation and Incentives: Competitive salary with annual merit increases and quarterly bonus opportunities.Flexibility: Work-from-home options several days a week.Professional Growth: Opportunities for career advancement and continued professional development.