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 Complex Case Manager (RN) to develop and manage individualized, comprehensive care plans for Pediatric members. This role involves promoting optimal, cost-effective health outcomes and serving as a vital liaison between members, families, healthcare providers, and community agencies.
Responsibilities / Job Duties
- Care Plan Development & Case Management
- Perform comprehensive clinical, physical, psychosocial, and functional assessments of complex adult members via phone, face-to-face, or medical record reviews.
- Create, implement, and update member-centric care plans; identify health disparities, care gaps, and barriers to compliance, adjusting interventions as needed.
- Lead multidisciplinary collaboration and case conferences to facilitate access to services, reduce avoidable hospitalizations, and coordinate with Behavioral Health and Long-Term Services and Supports (LTSS).
- Serve as a clinical resource and mentor to other case management staff by sharing best practices.
- Education & Community Liaison
- Teach members and caregivers about their specific care plans, healthcare benefits, and available community resources.
- Collaborate with network providers to support smooth transitions of care, medication reconciliation, and follow-up services.
- Represent the organization at community meetings and advocate on behalf of members to ensure quality care delivery.
- Quality Improvement & Compliance
- Participate in Quality Improvement studies targeting care access, member education, and behavioral health changes.
- Monitor performance indicators, audit case documentation for compliance, and contribute to annual program process improvements.
- Assist with internal and external audits, ensuring documentation strictly aligns with state and departmental regulations.
Minimum Education and Experience Qualification Requirements
Education
Qualifications
- Strong documentation skill set.
- Strong clinical judgement experience.
- Medicare experience highly preferred.
- Hospital case management experience.
- Bilingual (English/Spanish or English/Hmong) preferred.
- Experience working with Medicare, Medi-Cal, and/or D-SNP populations preferred.
- Experience working with ECM/CS and/or LTSS coordination preferred.
- Working knowledge of D-SNP program regulations, including Medicare-Medi-Cal alignment, MOC standards, and LTSS integration preferred.
Experience
- 5+ years of experience as a RN with at least 3+ years of experience case management experience.
Skills
- Strong documentation skills.
- Strong clinical judgment skills.
Schedule / Shift
- M-F 8am-5pm, 1 hour lunch
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.
*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.
