Registered Nurse Case Manager

Job Description

Job Description

Registered Nurse (RN) Case Manager

Location: San Ignacio Ave, San Jose, CA 95119
Schedule: Monday-Friday, 8:30 AM-5:00 PM
Work Setting: Fully Onsite
Position Type: Full-Time

Job Overview

We are seeking an experienced Registered Nurse (RN) Case Manager to join a highly rated California health plan in San Jose. In this role, you will serve as a member advocate, coordinating medical and psychosocial care to help members achieve their individualized health goals and maintain the highest possible level of independence.

The RN Case Manager will collaborate with members, families, primary care providers, specialists, behavioral health professionals, and community service providers to develop personalized care plans, coordinate services, and support positive, cost-effective health outcomes.

Key Responsibilities

• Maintain accurate, organized, and compliant case files in accordance with organizational policies, state and federal regulations, and audit requirements.

• Collaborate with members and their families or responsible parties to develop and implement individualized care plans with prioritized, member-specific goals.

• Coordinate care among primary care providers, specialists, behavioral health professionals, and Long-Term Services and Supports (LTSS) providers.

• Help members access necessary medical, behavioral health, and social services to maintain or improve their functional independence and remain safely in their homes or communities.

• Facilitate transitions between care settings by coordinating medical appointments, pharmacy assistance, follow-up services, and utilization review as appropriate.

• Support transitions from nursing facilities to lower levels of care or community-based settings in collaboration with applicable providers and programs, when assigned to MLTSS.

• Conduct telephonic assessments to evaluate member needs, identify barriers to care, and support the development of appropriate care plans.

• Advocate for members by connecting them with available healthcare benefits, community resources, and support services.

Required Qualifications

• Active, unrestricted California RN license.

• Minimum of 3 years of experience in case management, discharge planning, patient education, or an equivalent combination of relevant experience, education, or certifications.

• Knowledge of managed care principles and practices, particularly case management and/or utilization management.

• Strong clinical knowledge, critical-thinking skills, and the ability to assess whole-person healthcare needs.

• Ability to develop individualized care plans that address medical, psychosocial, and functional needs.

• Proficiency with Microsoft Outlook, Word, Excel, and the ability to navigate case management software and other computer applications.

• Strong communication, organization, care coordination, and problem-solving skills.

Preferred Qualifications

• Bilingual proficiency in Spanish, Vietnamese, Chinese, or Tagalog.

• Experience working with specific member populations, including behavioral health populations, seniors, individuals with disabilities, or children.

Why Consider This Opportunity?

• Opportunity to work with a highly rated California health plan.

• Competitive pay.

• Meaningful work advocating for members and helping them navigate the healthcare system.

• Collaborative, multidisciplinary care environment.

• Consistent weekday schedule, Monday through Friday.

If you are a California-licensed RN with case management experience and a passion for coordinating quality care, we encourage you to apply!

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.

\nCompany Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?

Company Description

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.\r\n\r\nOur commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?