Senior Complex Case Manager - Pediatric RN

Profile

We have an opportunity to join the Alliance as a Senior Complex Case Manager - Pediatric (RN) in the Utilization Management and Complex Case Management Department.

There is one position available and can be filled in any of our three offices (Scotts Valley, Merced or Salinas).

WHAT YOU'LL BE RESPONSIBLE FOR

You will develop and manage an individualized comprehensive plan of care for members referred into the assigned Case Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner; Work with and educate members, families, providers, external agencies and internal departments on the Case Management Program and provide assistance as needed; Participate in Quality Improvement studies, to continually evaluate the program’s effectiveness and ability in promoting quality driven, cost effective, achievable goals and outcomes for members.

ABOUT THE TEAM

We determine medical necessity and benefit coverage for our members based on industry standards

WHAT YOU'LL NEED TO BE SUCCESSFUL

To read the full position description, and list of requirements click here

Knowledge of:

The principles and practices of clinical nursing

The principles and practices of case management

Care management and coordination

Evidence-based practice guidelines in the development of care plans

Ability to:

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 and manage complex priorities

Education and Experience:

Current unrestricted license as a Registered Nurse issued by the State of California

Associate’s degree in Nursing and a minimum of five years of experience in a patient care setting, including at least one year of case management experience a combination of education and relevant work 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 the population of assignment (i.e. pediatrics or adults)

OTHER DETAILS

While this position is connected to one of our Alliance offices, we are in a fully telecommute work environment right now due to the COVID-19 pandemic. The interview and on-boarding process for this position will be completed remotely

This position

may

require onsite presence when our offices re-open, which will be no sooner than February 1, 2022. Onsite presence will most likely be on a part-time basis, but is dependent on business needs

COVID-19 Vaccine Requirement:

This position requires staff to be fully vaccinated upon their start date as a condition of employment. Proof of vaccination must be submitted at time of hire. Fully vaccinated is defined as receipt of the second dose in a 2-dose series (Pfizer & Moderna vaccines) OR receipt of a single-dose vaccine (Johnson & Johnson); AND receipt of the booster (if eligible); AND a 2-week period having passed since the administration of the last vaccine dose.

Additionally, all positions at the Alliance are required to meet these minimum qualifications

OUR BENEFITS

Medical, Dental and Vision Plans

Ample Paid Time Off

11 Paid Holidays per year

401(a) Retirement Plan

457 Deferred Compensation Plan

Robust Health and Wellness Program

EV Charging Stations

And many more

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 over 377,000 members in Santa Cruz, Monterey and Merced counties. To learn more about us, click here

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.

Company info

Central California Alliance for Health
Website : http://www.ccah-alliance.org/