RN, Clinical Care Manager I

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🕒 November 14, 2025

🏄 California – Remote

🏄 California – Remote

💵 $91.7k - $128.3k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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Gold Coast Health Plan

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2011

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Gold Coast Health Plan is a managed care health plan that provides comprehensive healthcare services to residents of Ventura County, California. Its mission is to deliver affordable, high-quality healthcare, including medical, dental, and mental health services, ensuring accessibility for all members. GCHP emphasizes compassionate care and community support through various programs focused on preventive health and enhanced care management.

📋 Description

• Assess and identify members who may benefit from additional education, clinical support, and connecting them with appropriate medical providers. • Promote the most cost-effective healthcare delivery by coordinating with the medical management team. • Engage members into care coordination activities to reduce care gaps. • Evaluate for and work toward elimination of barriers to care. • Formulation of a member-centric care plan in partnership with the member. • Collaborate with internal partners including but not limited to; social workers, health education, pharmacy staff and ECM/ Community Supports team, member services • Ensure confidentiality of utilization review, quality assurance information, and individual beneficiary identification • Assist with data collection for special member determination as required • Prepare written reports such as summaries of case management functions and updates of case status, use of covered services, supporting and reporting required metrics and other pertinent performance data, as directed • Provide accurate documentation to meet departmental policies, regulatory requirements and audits • Attend community meetings concerning health issues or provision of health-related services • Establish and maintain effective working relationships with community resources and service agencies • Strong organizational, delegation and task prioritization skills • Member advocacy focus • Knowledge of required regulatory timelines to ensure department compliance with State contracts • Ability to convey empathy and is nonjudgmental of the member • Demonstrates team support by consistently seeking opportunities to recognize and promote colleagues • Ability to stay calm and professional when working with internal and external partners • Exhibits accountability by maintaining good attendance • Adhere to all GCHP Policies and Procedures and meet required performance standards • Review referral requests for Enhanced Care Management and Community Supports referral requests. • Authorize referral requests for various ECM and CS providers. • Serve as liaison for Justice Involved population. • Attend National Health Foundation meetings with Enhanced Care Management. • Attend CalAim meetings with Ventura County. • Educate members, staff and providers about policies for ECM and CS.

🎯 Requirements

• Bachelor's Degree (four-year college or technical school) is preferred, Field of Study: in a health-related field and managed care experience is desired • Registered Nurse (RN) valid and current license. • 2 plus years of experience in the health care field. Required. • Care management, discharge planning, or equivalent combination of education and experience. • Managed care experience in a health plan, preferred. • Ability to evaluate clinical and other health data and to communicate effectively both orally and in writing. • Ability to synthesize thoughts and plans succinctly in writing. • Ability to balance multiple tasks. • Strong organizational skills. • Critical thinking skills. • Flexibility in role delineation and workload assignments. • Team player • Active, valid and unrestricted license, California Registered Nurse CCM or other CM certification preferred. • A valid and current Driver's License, Auto Insurance, and professional licensure(s) • Bilingual in English and Spanish preferred

🏖️ Benefits

• Flexible work environment • GCHP promotes a flexible work environment