Managed Care Case Manager RN ~ Central Valley Health Plan

$101,629 - $147,368/Yr

Saint Agnes Medical Center - Fresno, CA

Full-time - Mid Level

Fresno, CA

Hospitals

About the position

The Managed Care Case Manager RN at Central Valley Health Plan is responsible for coordinating care and services for defined patient populations across the acute care continuum. This role involves discharge planning, utilization management, and care coordination, working collaboratively with an interdisciplinary team to enhance patient care and optimize resource utilization. The position aims to achieve desired clinical, financial, and resource utilization outcomes.

Responsibilities

• Coordinate care and service for defined patient populations across the acute care continuum.
• Conduct discharge planning and utilization management.
• Facilitate care coordination and support for resource utilization.
• Collaborate with an interdisciplinary team to improve patient care.
• Contribute to achieving desired clinical, financial, and resource utilization outcomes.

Requirements

• High school diploma or equivalent required; a degree from an accredited baccalaureate nursing program is preferred.
• Current licensure as a Registered Nurse in California is required.
• Current American Heart Association (AHA) Healthcare Provider CPR card is required.
• CCM national certification is preferred.
• Experience with two areas of clinical specialty is preferred.
• Excellent communication skills, critical thinking, and creative problem-solving skills are required.
• Ability to be self-directed and manage a demanding workload is required.
• Knowledge of hospital protocols, clinical standards, funding options, and community resources is preferred.

Nice-to-haves

• Experience in Home & community care is preferred.