RN Clinical Case Manager

RN Clinical Case Manager

Riverside, CA

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!

Position Summary

The RN Clinical Care Manager (CCM) serves as a trusted partner and advocate for members, providing compassionate, coordinated, and person-centered care within the Enhanced Care Management (ECM) program. This role combines the relational and member-engagement strengths of the Lead Care Manager with the clinical expertise and system coordination responsibilities of an RN Case Manager.

Under the general supervision of Enhanced Care Management Leadership, the RN Clinical Care Manager develops and implements personalized care plans, conducts comprehensive assessments, facilitates care transitions, and builds strong, trusting relationships with each member. Through collaboration with Primary Care Providers (PCPs), interdisciplinary care teams, and community partners, the CCM ensures that members receive the right care, at the right time, in the right placesupporting improved outcomes and health equity for diverse Medi-Cal populations.

Key Responsibilities

Member Engagement and Relationship Building

• Visit members in-person and virtually to conduct initial and ongoing assessments of medical, behavioral, and social needs.
• Build rapport with members and families, fostering trust and empathy to support long-term engagement and self-sufficiency in health.
• Provide compassionate emotional support, active listening, and culturally sensitive coaching to empower members in their care journey.
• Respond promptly and professionally to member inquiries, concerns, and care needs, ensuring service adherence to legal and payer guidelines.

Care Coordination and Clinical Oversight

• Develop and maintain individualized, whole-person care plans based on comprehensive assessments addressing physical health, behavioral health, substance use, long-term care, housing, and social service needs.
• Work collaboratively across the healthcare continuumprimary care, specialists, hospitals, behavioral health, and community agenciesto integrate medical and social support.
• Monitor member progress and outcomes, adjust care plans as needed, and ensure regular follow-up through telehealth and in-person interactions.
• Facilitate safe and effective care transitions, including discharge planning, follow-up appointments, and home-based care coordination.
• Advocate for timely access to appropriate treatments, medications, and support services.

Clinical Leadership and Quality Improvement

• Review utilization patterns of high-risk patients and work with healthcare teams to design interventions that reduce avoidable hospital and ED visits.
• Analyze payer and quality performance reports to identify care gaps and implement improvement strategies.
• Participate in developing and training team members on quality improvement, safety, and case management best practices.
• Maintain compliance with Medi-Cal, HEDIS, and quality standards while advancing health equity across all populations.

Population Management

Manage a caseload of members within ECM's populations of focus, including but not limited to:

• Individuals experiencing homelessness
• Those with serious mental illness and/or substance use disorders
• Individuals transitioning from incarceration
• High utilizers of emergency services
• Adults at risk of institutionalization or transitioning from nursing facilities
• Pregnant/postpartum individuals facing racial or ethnic birth inequities
• Children and youth in child welfare or California Children's Services (CCS)

Qualifications

Required

• Current California RN license in good standing.
• 23 years of clinical experience in case management, acute care, ICU/CCU, or home health.
• Strong understanding of Medi-Cal, care coordination, and social determinants of health.
• Excellent analytical, clinical judgment, interpersonal, and communication skills.
• Proficiency in MS Office (Excel, Word, Outlook) and electronic health record systems.
• Valid California driver's license, car insurance, and access to a reliable vehicle.
• Ability to travel locally for member visits; mileage reimbursement provided.
• Compassionate, nonjudgmental, and culturally sensitive approach.

Preferred

• Bachelor's or Associate degree in Nursing, Healthcare Administration, or a related field.
• Bilingual, Spanish.
• Certified Case Manager (CCM) or equivalent certification.
• Experience in Managed Care, Community Health, or Behavioral Health settings.
• Certification or experience using Motivational Interviewing or empathy-based communication strategies.
• Familiarity with regional health disparities and principles of self-management support for chronic conditions.

Physical and Work Requirements

• Prolonged periods sitting at a desk or driving for community visits.
• Frequent computer usage; must be able to lift up to 10 pounds.
• Occasional evening or weekend work within a 40-hour week.

This position provides a unique opportunity to combine clinical expertise with compassionate engagement in the communityempowering members to achieve their health goals through trust, advocacy, and coordinated, person-centered care.

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.