Employment Type: Full-Time | Temporary (July 2026 - December 2026)
Schedule: Monday-Friday | 8:00 AM-5:00 PM (1-hour lunch)
Compensation: $56.00-$64.00/hour (Based on California geographic zone)
We're seeking an experienced Senior Complex Case Manager (RN) to support a Medicare Dual Eligible Special Needs Plan (D-SNP) Case Management Program on a temporary full-time assignment through the end of 2026. This role is ideal for an RN with strong case management, care coordination, and clinical decision-making experience who is passionate about improving outcomes for medically complex adult members.
This is a primarily remote position, allowing you to work from home for the majority of your assignment. Candidates should reside within 1-2 hours of one of our regional office locations, as occasional in-office attendance may be required for department meetings, trainings, collaboration, or other business needs.
As a Senior Complex Case Manager, you'll develop and manage individualized, comprehensive care plans for adult members with complex medical, behavioral, and psychosocial needs. You'll collaborate with providers, caregivers, and community organizations to improve health outcomes, reduce avoidable hospitalizations, and ensure members receive coordinated, high-quality care.
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Perform comprehensive clinical, physical, psychosocial, and functional assessments through telephonic outreach, face-to-face visits (as needed), and medical record reviews.
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Develop, implement, and regularly update individualized, member-centered care plans.
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Identify health disparities, gaps in care, barriers to treatment compliance, and social determinants of health while implementing appropriate interventions.
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Coordinate care across primary care providers, specialists, behavioral health teams, Long-Term Services and Supports (LTSS), and community organizations.
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Lead multidisciplinary care conferences to improve coordination and reduce unnecessary emergency department visits and hospital admissions.
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Serve as a clinical resource and mentor by sharing case management best practices with team members.
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Educate members and caregivers on care plans, chronic disease management, healthcare benefits, and available community resources.
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Collaborate with providers to facilitate transitions of care, medication reconciliation, and post-discharge follow-up.
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Act as a liaison between members, providers, caregivers, and community agencies to promote quality, coordinated care.
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Represent the organization at community meetings and advocate for member needs.
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Participate in Quality Improvement initiatives focused on improving access to care, member education, and health outcomes.
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Monitor performance metrics and audit documentation to ensure regulatory compliance and documentation accuracy.
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Support internal and external audits while maintaining compliance with state, federal, and departmental guidelines.
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Contribute to ongoing process improvement initiatives that enhance program effectiveness and member outcomes.
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Active, unrestricted California Registered Nurse (RN) license.
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Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN).
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Minimum of 5 years of RN experience, including at least 3 years of Case Management experience.
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Strong clinical judgment and critical thinking skills.
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Excellent documentation and care planning experience.
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Strong communication, organization, and interdisciplinary collaboration skills.
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Medicare or Medicare Advantage experience.
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Hospital Case Management experience.
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Experience working with Medicare, Medi-Cal, and/or D-SNP populations.
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Experience coordinating Enhanced Care Management (ECM), Community Supports (CS), and/or Long-Term Services and Supports (LTSS).
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Working knowledge of D-SNP program regulations, Medicare-Medi-Cal alignment, Model of Care (MOC) standards, and LTSS integration.
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Bilingual in English/Spanish or English/Hmong.
This position is primarily remote, but candidates should live within a reasonable driving distance (approximately 1-2 hours) of one of the following regional office locations, as occasional onsite attendance may be required based on business needs:
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Scotts Valley, CA 95066
- Salinas, CA 93901
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Merced, CA 95340
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Mariposa, CA 95338
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Zone 1: $60.00-$64.00/hour
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Zone 2: $56.00-$60.00/hour
For California Applicants:
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
