RN Case Manager – Transition of Care, Bilingual Spanish

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $79.7k - $119.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💬 Bilingual

👻 Ghost score 0%

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

🛡️ Insurance

🏥 Healthcare

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Ensure member access to services appropriate to their health needs • Identify, assess, and manage members per established criteria • Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements • Use independent judgment to determine authorization appropriateness and deploy internal and external resources to meet identified needs • Monitor and evaluate care management plan effectiveness and modify plans as necessary • Interface with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on care management treatment plans • Negotiate rates of reimbursement, as applicable • Assist with provider, claims, or service issue problem-solving • Measure intervention effectiveness to determine case management outcomes • Participate in and provide feedback on utilization and care management policies and procedures • Counsel and engage patients and families on available care options and help determine appropriate and preferred courses of action • Perform duties mostly telephonically

🎯 Requirements

• Minimum 5 years of clinical case management experience; or any combination of education and experience, which would provide an equivalent background • Associates or Bachelor's degree in Nursing • Current, unrestricted RN license in the state for which you are applying • Ability to communicate positively, professionally and effectively with others; provide 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 • Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment • Ability to meet the stated essential physical functions, including standing, walking, sitting, hand and finger use, reaching, talking, hearing, lifting and moving up to 10 pounds, close vision, and adjusting focus