RN Case Manager

Job Description

Job Description

Empowering Wellness, Transforming Lives

Optima Medical Management Group is dedicated to enhancing the quality of life by promoting wellness. At Optima MMG and all of its divisions: Serene Health, Community Support, and American TrueCare, our mission is to provide comprehensive support and care that not only addresses immediate concerns but also fosters long-term well-being.

As pioneers in the field, we aspire to lead in member care outcomes and set new standards for excellence and innovation. We are committed to empowering our members to achieve self-sufficiency in health, creating a ripple effect that strengthens families and communities.

Our work culture at Optima MMG is built on pride, passion, and a collective commitment to making a positive difference in people's lives. Our team members are dedicated problem-solvers who bring their unique skills and perspectives to the table. We believe that by fostering a collaborative and supportive environment, we can unlock the full potential of our team and, in turn, provide the best possible care to our members.

A career at Optima MMG is an opportunity to be part of a dynamic and forward-thinking organization. We encourage continuous learning and professional growth, providing our employees with access to industry experts, cutting-edge technologies, and a supportive community that values each individual's contributions. Join us on this journey to not only advance your career but to be a driving force in transforming lives and communities through passionate and fulfilling work!

Job Summary:  

The RN Clinical Case Manager provides clinical assessment, care plan development, and ongoing clinical oversight within the Enhanced Care Management (ECM) program. 

This role requires a bilingual skillset in English and Spanish.

This is a non-bedside, RN-led role. The RN Clinical Case Manager serves as the clinical authority for ECM care planning, ensuring medical appropriateness, risk identification, and regulatory compliance. The RN works in close collaboration with ECM Lead Care Managers, who are responsible for care coordination, member engagement, and non-clinical assessments. 

Core Responsibilities:  

• Conduct clinical assessments based on medical history, diagnoses, utilization patterns, medications, and risk indicators. 

• Develop, review, and clinically approve individualized ECM care plans. 

• Identify and monitor clinical and utilization risks impacting member outcomes. 

• Provide RN clinical oversight and guidance to ECM Lead Care Managers executing care plans. 

• Review medication lists for safety concerns, adherence issues, and escalation needs. 

• Collaborate with primary care providers, behavioral health clinicians, and internal care teams. 

• Support transitions of care following emergency department visits, hospitalizations, or other significant events. 

• Ensure care plans are updated based on changes in clinical status or utilization patterns. 

• Ensure care plans and clinical documentation meet Medi-Cal, CalAIM, and ECM program requirements. 

• Participate in audits, chart reviews, and quality improvement initiatives. 

• Provide clinical education and consultation to ECM staff as needed. 

• Contribute to the development and refinement of clinical workflows, tools, and best practices. 

• Maintain timely, accurate, and compliant clinical documentation. 

• Prepare clinical summaries, care plan updates, and progress notes. 

• Support internal reporting related to member outcomes, utilization, and care plan progress. 

• Performs other duties as assigned.  

Required Qualifications:   

• Active California RN license. 

• Associate Degree in Nursing (ADN) required; BSN preferred. 

• Minimum 3 years of clinical nursing experience. 

• Experience working with Medi-Cal and/or managed care populations. 

• Strong clinical judgment and communication skills. 

• Ability to work independently and collaboratively. 

Preferred Qualifications  

• Case management or utilization management experience. 

• Familiarity with Enhanced Care Management (ECM) or Health Home programs. 

• Experience supporting audits or regulatory reviews. 

• Training in Motivational Interviewing or trauma-informed care. 

Physical Requirements:   

• Prolonged periods of computer-based work. 

• Ability to lift 10 pounds. 

• Flexibility to support program operations. 

Pay range

$90,000—$110,000 USD

Benefits

Our full-time employees are eligible for the following benefits enrollment after 60 days of employment:

Medical, Dental, & Vision Benefits: We have various insurance options for you and your family.

Short & Long-Term Disability Benefits: Protection when you need it most.

Voluntary Accident, Voluntary Critical Illness, and Voluntary Hospital Indemnity Plans: Added security for you and your loved ones.

Flexible Spending Accounts: Manage your finances with flexibility.

Employee Assistance Program (EAP): Support when life throws challenges your way.

401(K): Building your financial future with us. Effective after 1 year of employment.

Paid Vacation and Sick Leave: Flexibility for the planned and unplanned.

Paid Holidays: Quality time to enjoy celebrations.

Employee Referral Program: Share the opportunities and reap the rewards.

Company Discount Program: Enjoy savings on everyday expenses and memberships.

Equal Employment Opportunity

Optima Medical Management Group and its divisions are an Equal Opportunity Employer. Optima MMG is committed to providing employment opportunities for all qualified candidates without discrimination on the basis of race, religion, sex, sexual orientation, gender identity, age, national origin, citizenship, disability, marital status, veteran status, or any other characteristic protected by federal, state or local laws. Optima MMG is committed to providing reasonable accommodation for individuals with disabilities.

Pre-Employment

Optima Medical Management Group is a drug-free workplace. Employment is contingent upon a successful pre-employment drug screening and background check.