Care Management Nurse, New Century Health Plan

Description

Step into a vital role at New Century Health Plan and coordinate the care for our Medicare Advantage members. As a Care Management Nurse, you will focus on improving health outcomes and streamlining the care journey for members with complex healthcare needs.

In this position, you will work closely with members, their families, and healthcare providers. Your responsibilities will include:

• Develop, implement, and monitor individualized care plans based on Health Risk Assessment.
• Facilitate transitions of care, including hospital discharge planning and follow-up.
• Close care gaps for members enrolled in the Complex Care Management program.
• Support the Appeals & Grievances team in resolving members' concerns.
• Collaborate with medical director in investigating potential quality issues.

Salary Range: $129,018- $166,852/annually

Job Qualifications
Qualifications

We're seeking a highly qualified candidate with:

• An RN is required, along with a current unrestricted nursing license to practice in California.
• A minimum of 3 years of clinical nursing experience, preferably in care management, care coordination, or a related field.
• Experience with Medicare Advantage plans and knowledge of CMS regulations is highly desired.
• Strong assessment and critical thinking skills, with the ability to work independently and as part of a team.
• Proficiency in electronic health records (EHR) and care management software, along with exceptional organizational and time management skills.
• Dependability, integrity, initiative, and a strong ethical standard, with attention to detail and the ability to learn quickly.
• Exceptional interpersonal, written, and verbal communication skills.
• Proficiency in Microsoft Office applications (Word, Excel, PowerPoint).
• A proactive approach to take initiative while appropriately soliciting input and advice.

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