RN Case Manager - San Jose - Medical Professionals

    Medical Professionals
    Medical Professionals San Jose

    5 days ago

    Description

    We are seeking an experienced RN Case Manager to provide ongoing medical and psychosocial case management services for health plan members. This role serves as a strong member advocate, coordinating care across interdisciplinary teams to ensure individualized goals are met and services are delivered efficiently, compliantly, and compassionately.

    The RN Case Manager develops and implements personalized care plans, supports transitions of care, and collaborates closely with providers, community resources, and internal teams to promote high-quality, cost-effective outcomes across the healthcare and social services continuum.

    Schedule: Monday–Friday | 8:00 AM – 5:00 PM

    Location: San Jose, California

    Key Responsibilities

    • Conduct, document, and evaluate comprehensive clinical and psychosocial assessments and ongoing follow-ups.
    • Develop, implement, and monitor individualized care plans in collaboration with members and families.
    • Maintain accurate, compliant, and audit-ready case documentation in accordance with state and federal regulations.
    • Coordinate care with primary care providers, specialists, behavioral health providers, and long-term services and supports.
    • Facilitate interdisciplinary communication among internal teams, providers, community agencies, and vendors.
    • Support smooth transitions of care across settings, including medical appointments, pharmacy coordination, and utilization review.
    • Conduct telephonic and in-person assessments in homes, facilities, or community settings as needed.
    • Participate in quality improvement initiatives, utilization management optimization, and member satisfaction efforts.
    • Attend required meetings, trainings, and off-site sessions as assigned.

    Additional Assignments May Include:

    MLTSS:

    • Supporting transitions from nursing facilities to community or lower levels of care.

    CBAS:

    • Conducting face-to-face eligibility assessments using state-approved tools
    • Reviewing and approving Individual Plans of Care
    • Providing targeted care coordination and care transitions

    Required Qualifications

    • Minimum 3 years of experience in case management, discharge planning, or related clinical roles
    • Strong knowledge of managed care, utilization management, and case management principles
    • Excellent clinical judgment, critical thinking, and care-planning skills
    • Ability to meet regulatory, documentation, and timeline requirements consistently
    • Experience working within interdisciplinary care teams
    • Ability to conduct home and community-based visits
    • Valid California driver's license with acceptable driving record (or reliable alternative transportation)
    • Proficiency with Microsoft Outlook, Word, Excel, and case management systems
    • Strong verbal and written communication skills
    • Ability to prioritize, multitask, and perform effectively under pressure
    • Commitment to confidentiality, professionalism, and safety

    Preferred Qualifications

    • Bilingual skills in Spanish, Vietnamese, Chinese, or Tagalog
    • Experience working with behavioral health populations, seniors, individuals with disabilities, or children

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