Remote Telephonic Registered Nurse Case Manager

Position Title: Remote Telephonic RN Case Manager Mandatory Requirement: Must hold an Active Compact RN License and/or an Active California (CA) RN License to be considered. Pay Rate: $48.00 – $50.00 per hour (Dependent on Experience) Location: 100% Remote (Must reside in the U.S.) Schedule: Monday – Friday, 8:00 AM – 5:00 PM PST (No flexibility; includes a 1-hour lunch break and two 15-minute breaks) Required Languages: Fully Bilingual (Fluent in English & Spanish) Position Summary We are seeking a compassionate, tech-savvy, and self-motivated Registered Nurse (RN) to join our team as a Remote Telephonic RN Case Manager. In this role, you will provide telephonic case management to medically complex and chronically ill members within a Chronic Condition Special Needs Plan (C-SNP) population. This is a high-volume, phone-based position where you will make 30–40 calls per day (spending approximately 3–4 hours on the phone daily) to help seniors and complex care patients navigate their healthcare journeys, close gaps in care, and improve health outcomes. Key Responsibilities Case Management & Assessment: Provide telephonic case management for complex, chronically ill members; conduct comprehensive health assessments and develop tailored, individualized care plans. Member Education: Deliver clinical and disease-state education (e.g., CHF, A1C/diabetes management, lab results, medications, and general blood work). Interdisciplinary Collaboration: Coordinate care with internal and external healthcare partners. Prepare and present member cases during Interdisciplinary Care Team (ICT/IDT) meetings with Nurse Practitioners, Regional Medical Officers (RMOs), and Social Workers. Gaps in Care & Advocacy: Identify service/access barriers and proactively resolve gaps in care. Delegation & Coordination: Delegate non-clinical coordination tasks (such as transportation, appointment scheduling, and referrals) to assigned Care Coordinators. Documentation: Accurately document all clinical notes, member interactions, and care plans directly into the care management documentation system in a timely manner. Call Volume: Manage a high-volume call queue, consisting of roughly 80% outbound outreach (from queue/task lists) and 20% inbound member/partner calls. Required Qualifications Licensure: Active, current RN License in a Compact State and/or active California RN License. Experience: Minimum of 1 year of dedicated Case Management experience. Language Skills: Fully bilingual and fluent in both Spanish and English (verbal and written). Technical Skills: Strong computer proficiency, efficient typing, and accurate real-time note-taking capabilities. Home Office Setup: Must have a dedicated, quiet, and secure HIPAA-compliant home workspace suitable for handling confidential patient calls. Preferred Qualifications Licensure: Active Nevada RN License in addition to Compact/CA license. Education: Bachelor of Science in Nursing (BSN). Industry Experience: Previous experience working within a Health Plan, Independent Physician Association (IPA), or Managed Care Organization (MSO). Knowledge Base: Familiarity with Medicare Advantage, C-SNP, and Medicaid vs. Medicare structures. Key Attributes & Soft Skills Compassionate Care: A true passion for serving seniors and medically complex populations. Communication: Exceptional verbal communication and patient education skills. Adaptability: Self-motivated, proactive, and able to think quickly on your feet and pivot as member needs arise. Equipment: A complete desktop computer setup and multiple monitors will be provided by the employer. (Candidates must be anchored to a dedicated desktop workspace at home; mobile/remote work setups such as RVs are not permitted). PST Hours: Candidates may work from anywhere in the U.S., but must adhere strictly to Pacific Standard Time (PST) operating hours. #J-18808-Ljbffr