Senior Complex Case Manager

There are 2 positions available as a Senior Complex Case Manager (RN) within the Care Management Department at the Alliance. 

WHAT YOU'LL BE RESPONSIBLE FOR

Reporting to the Medicare Care Management Manager (RN), this position: 

• Develops and manages an individualized comprehensive plan of care for Medicare Dual Eligible Special Needs Plan (D-SNP) members referred into the Case Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner
• Works with and educates members, families, providers, external agencies, and internal departments on the D-SNP Case Management Program
• Participates 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 
• Performs D-SNP Program oversight and support activities
• Acts as a liaison between the D-SNP Program and providers and community agencies to promote effective implementation of program objectives and requirements 

ABOUT THE TEAM

The Care Management Department's mission is to coordinate care and empower members to achieve their health and wellness goals through collaboration and by facilitating member relationships with community providers. We bring the voice of the member into the room when collaborating with our fellow departments at the Alliance.

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, including motivational interviewing and evidence-based guidelines 
• Care management and coordination 
• Complex chronic conditions, geriatric care, and psychosocial factors impacting health outcomes 
• The principles and practices of developing and implementing health improvement strategies to address social determinants of health 
• Evidence-based practice guidelines in the development of care plans 
• Electronic health record and/or care management platforms 
• Ability to:
  • Assess member risk, define problems, develop care plans, and collaborate across disciplines 
  • 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, manage complex priorities, and document with accuracy and timeliness 
  • Communicate effectively with a diverse population of members, including those with behavioral health issues 
• 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 seven years of experience in a patient care setting, including a minimum of one year of case management experience (a Bachelor’s degree may substitute for two years of the required experience); or an equivalent combination of education and 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 adults and/or dual-eligible populations

OTHER INFORMATION

• We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

COMPENSATION INFORMATION

• Zone 1 Pay Range: $125K - $140K
  Typical areas in Zone 1: Santa Cruz, San Benito, and Monterey Counties, Bay Area, Sacramento, Los Angeles and San Diego areas
  
  
• Zone 2 Pay Range: $120K - $135K
  Typical areas in Zone 2: Mariposa and Merced Counties, Fresno area, Bakersfield, Eastern California, San Luis Obispo area, and the Central Valley (except Sacramento)

The applicable salary ranges are based on work location and are aligned to a zone according to the cost of labor in your area. All ranges are subject to change in the future. We are happy to provide the full compensation range for the role, answer any questions that you have, or share the applicable pay zone for your location if it’s not one of the typical areas listed. You can reach out to [email protected], and a member from our Talent Acquisition team will be in touch.

The hiring ranges represent a good‑faith estimate of what we expect to pay for this role upon hire and are not the full compensation ranges. Employees typically have opportunities for growth within the full compensation range over time based on performance and merit. Final compensation will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education, or training), as well as other factors (internal equity, market factors, and geographic location).