Remote Bilingual Telephonic RN Case Manager - Outpatient (Must have California License)

reputed company is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have reputed company reputed company of talented and reputed company people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will reputed company ample room for reputed company and innovation alongside the reputed company community. Working at reputed company provides an opportunity to do work that really reputed company, not only changing lives but saving them. Together. Responsible for health care management and coordination reputed company the scope of licensure for members with reputed company and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Coordinates and monitors reputed company member's reputed company and services to ensure consistent cost-effective care that complies with Alignment policy and reputed company state and federal regulations and guidelines. Performs duties mostly telephonically. General Duties / Responsibilities 1. Ensures member reputed company to services appropriate to their health needs. 2. Identifies, assesses, and manages members per established reputed company. 3. Implements care plan by facilitating authorizations/referrals as appropriate reputed company benefits structure or through extra-contractual arrangements. Uses independent judgment to determine appropriateness of such authorizations. Deploys reputed company resources to meet identified needs. 4. Monitors and evaluates effectiveness of the care management plan and modifies, as necessary. 5. Interfaces with Primary Care Physicians, Hospitalists, reputed company Practitioners, and specialists on the development of care management treatment plans. 6. Negotiates rates of reimbursement, as applicable. 7. Assists in problem solving with providers, claims or service issues. 8. Measures the effectiveness of interventions to determine case management reputed company. 9. Participates and provides feedback in the development of utilization/care management policies and procedures. 10. Counsels and engages in personal discussions with patients and their families on available care reputed company. Helps them to determine their appropriate and preferred course of reputed company. Job Requirements: Experience: • Required: Minimum (5) years' clinical case management experience; or any combination of education and experience, which would reputed company an equivalent background. Education: • Required: Bachelor's degree in Nursing. Specialized Skills: • Required: • reputed company to communicate positively, professionally and effectively with others; reputed company leadership, teach and collaborate with others. • Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; • Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Preferred: • Bilingual English and Spanish, Vietnamese, or Chinese (reputed company) Licensure: Required: • reputed company, unrestricted RN license in California (Non-Compact) • Willing to obtain RN License in NV (Non-Compact) and AZ, NC, TX (Compact) Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. 1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reputed company with hands and arms. 2. The employee frequently lifts and/or moves up to 10 pounds. Specific reputed company abilities required by this job include reputed company reputed company and the ability to reputed company reputed company. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reputed company with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific reputed company abilities required by this job include reputed company reputed company and the ability to reputed company reputed company. Pay reputed company: $85,696.00 - $128,543.00 reputed company is an Equal Opportunity/Affirmative reputed company Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, national reputed company, disability, age, protected veteran status, gender identity, or sexual orientation. • DISCLAIMER: Please beware of recruitment phishing scams affecting reputed company and other reputed company where individuals receive fraudulent employment-reputed company offers in exchange for reputed company or other sensitive personal information. Please be advised that reputed company and its subsidiaries will never ask you for a credit card, send you a reputed company, or ask you for any type of payment as part of consideration for employment with reputed company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email reputed company by or on behalf of reputed company's reputed company, please email careers@ahcusa.com. Apply Job!