Senior Complex Case Manager (RN) D-SNP

OUR COMMITMENT TO A HUMAN HIRING PROCESS

We believe every candidate deserves thoughtful wedo not use AI or automated systems toreview applications. Every application is reviewed bya realhumanmember of our team. Because we take the time to give each submission the attention it deserves our review process may take a little longer and we genuinely appreciate your patience as we work through applications carefully and respectfully.

SERVICE AREA PREFERENCE

While we encourage all interested applicants to apply we do give priority to those who live in or near our service counties: Santa Cruz Monterey Merced San Benito and Mariposa. Our mission ofaccessible quality health care guided by local innovationleadseverything we do and having team members who are connected to the communities we serve strengthens our ability to deliver on that commitment.

There are 2 positions available as a Senior Complex Case Manager (RN) within the Care Management Department at the Alliance.

WHAT YOULL BE RESPONSIBLE FOR

Reporting to the Medicare Care Management Manager (RN) this position:

• Develops and manages an individualized comprehensive plan of care for Medicare Dual Eligible Special Needs Plan (D-SNP) members referred into the Case Management Program with the goal of promoting optimal achievable outcomes in the most cost effective and appropriate manner
• Works with and educates members families providers external agencies and internal departments on the D-SNP Case Management Program
• Participates in Quality Improvement studies to continually evaluate the programs effectiveness and ability in promoting quality driven cost effective achievable goals and outcomes for members
• Performs D-SNP Program oversight and support activities
• Acts as a liaison between the D-SNP Program and providers and community agencies to promote effective implementation of program objectives and requirements

ABOUT THE TEAM

The Care Management Departments mission is to coordinate care and empower members to achieve their health and wellness goals through collaboration and by facilitating member relationships with community providers. We bring the voice of the member into the room when collaborating with our fellow departments at the Alliance.

WHAT YOULL NEED TO BE SUCCESSFUL

To read the full position description and list of requirementsclick here.

• Knowledge of:
• The principles and practices of clinical nursing
• The principles and practices of case management including motivational interviewing and evidence-based guidelines
• Care management and coordination
• Complex chronic conditions geriatric care and psychosocial factors impacting health outcomes
• The principles and practices of developing and implementing health improvement strategies to address social determinants of health
• Evidence-based practice guidelines in the development of care plans
• Electronic health record and/or care management platforms
• Ability to:
  • Assess member risk define problems develop care plans and collaborate across disciplines
  • Demonstrate strong critical thinking and problem-solving skills
  • Interpret and apply policies and regulations
  • Define issues conduct research interpret data and identify and evaluate options
  • Evaluate medical records and other health care data
  • Organize work manage complex priorities and document with accuracy and timeliness
  • Communicate effectively with a diverse population of members including those with behavioral health issues
• Education and Experience:
  • Current unrestricted license as a Registered Nurse issued by the State of California
  • Associates degree in Nursing and a minimum of seven years of experience in a patient care setting including a minimum of one year of case management experience (a Bachelors degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying
  • A minimum of one year of the required patient care experience must be in an acute or outpatient environment working with adults and/or dual-eligible populations

OTHER INFORMATION

• We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

COMPENSATION INFORMATION

• Zone 1 Pay Range: $125K - $140K
  Typical areas in Zone 1: Santa Cruz San Benito and Monterey Counties Bay Area Sacramento Los Angeles and San Diego areas
  
  
• Zone 2 Pay Range: $120K - $135K
  Typical areas in Zone 2: Mariposa and Merced Counties Fresno area Bakersfield Eastern California San Luis Obispo area and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role answer any questions that you have or share the applicable pay zone for your location if its not one of the typical areas listed. You can reach out to and a member from our Talent Acquisition team will be in touch.

The hiring ranges represent a goodfaith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy analysis of the selected candidates qualifications (direct or transferable experience related to the position education or training) as well as other factors (internal equity market factors and geographic location).

OUR BENEFITS

Available for all regular Alliance employees working more than 30 hours per benefits are available on a pro-rated basis for part-time employees. These benefits are unavailable to temporary employees while on an assignment with the Alliance.

• Medical Dental and Vision Plans
• Ample Paid Time Off
• 12 Paid Holidays per year
• 401(a) Retirement Plan
• 457 Deferred Compensation Plan
• Robust Health and Wellness Program
• Onsite EV Charging Stations

ABOUT US

We are a group of over 500 dedicated employees committed to our mission of providing accessible quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Join us at Central California Alliance for Health (the Alliance) where you will be part of a culture that is respectful diverse professional and fun and where you are empowered to do your best work. As a regional non-profit health plan we serve members in Mariposa Merced Monterey San Benito and Santa Cruz counties. To learn more about us take a look at ourFact Sheet.

The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race color religion sex (including pregnancy) sexual orientation gender perception or identity national origin age marital status protected veteran status or disability status. We are an E-Verify participating employer

At this time the Alliance does not provide any type of sponsorship. Applicants must be currently authorized to work in the United States on a full-time ongoing basis without current or future needs for any type of employer supported or provided sponsorship.

Required Experience:

Manager

Employment Type : Full Time
Experience: years
Vacancy: 1
Monthly Salary Salary: 125 - 140