You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a dedicated Telephonic Case Manager to provide comprehensive telephonic case management to medically complex and chronically ill members (C-SNP population). This role involves conducting health assessments, creating individualized care plans, coordinating care with internal and external partners, and providing essential clinical/disease state education.

Responsibilities / Job Duties

• Provide telephonic case management to medically complex and chronically ill members (C-SNP population).
• Conduct comprehensive health assessments and create individualized care plans.
• Coordinate care with internal and external partners.
• Conduct ICT/IDT meetings, presenting members to nurse practitioners/RMOs and social workers.
• Provide clinical/disease state education (e.g., CHF, A1C, medications, labs).
• Identify gaps in care and resolve service/access issues.
• Spend 3–4 hours/day on the phone making ~30–40 calls (combination of 80% outbounds from queue/task list and 20% inbounds).
• Document directly in the AVA care plan system.
• Delegate non-clinical coordination (appointments, transportation, referrals) to assigned Care Coordinators.

Minimum Education and Experience Qualification Requirements

Qualifications

• Compact State RN License - active and current.
• Fully Bilingual/Fluent in Spanish and English.
• Must have a HIPAA compliant work space.
• CA RN License, and/or Nevada RN License (Preferred).
• Familiarity with Medicare Advantage / Medicaid vs. Medicare (Preferred).
• Bachelor's Degree in Nursing (BSN) (Preferred).
• Previous health plan or IPA experience highly preferred (Preferred).

Experience

• 1 Year of Case Management Experience.

Skills

• Strong verbal communication skills.
• Good computer and typing skills, with the ability to self-note take and document in the care plan.
• Comfortable educating on disease states, blood work, medications, and labs.
• Self-motivated.

Additional Requirements

• Must have a HIPAA compliant work space.
• Fully Remote position.
• May work from anywhere in the U.S., but must adhere to Pacific Time hours.

Schedule / Shift

• Monday-Friday, 8:00 AM - 5:00 PM PST (no flexibility available).
• Includes a one-hour lunch break and two 15-minute breaks.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

Medix is an equal opportunity employer and does not discriminate in employment on the basis of race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

^*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).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient’s residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. 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.