Remote Complex Care Registered Nurse - California Residents Only (Active California RN License Required | Bilingual English/Spanish Preferred)

Job Summary

Required Qualifications

• •Minimum 3 years of clinical RN experience
• •Direct patient care in complex care, care management, transitions of care, case management, palliative care/hospice, acute care, or a related clinical setting
• •Experience managing medically complex, high-risk patient populations
• •Experience with chronic disease management
• •Experience with medication reconciliation
• •Experience with care transition coordination
• •Prior experience in a Medicare Advantage, managed care, home-based care, or value-based care environment
• •Working knowledge of HEDIS
• •Working knowledge of HCC coding
• •Working knowledge of care gap management
• •Experience working in a telehealth or virtual care delivery model
• •Proficiency in virtual member engagement
• •Proficiency in remote clinical monitoring
• •Demonstrated ability to coordinate care across multiple disciplines
• •Ability to communicate effectively with clinical and non-clinical team members
• •Associate Degree in Nursing (ADN)
• •Bachelor of Science in Nursing (BSN)
• •Active, unrestricted Registered Nurse (RN) license in applicable state(s)
• •Current BLS certification
• •Demonstrated proficiency with telehealth delivery platforms
• •Working knowledge of Medicare Advantage benefits
• •Working knowledge of care coordination protocols
• •Working knowledge of transitions of care standards
• •Ability to own and manage the full care journey for high-acuity Medicare Advantage members
• •Ability to maintain consistent engagement
• •Ability to coordinate across disciplines
• •Ability to proactively address clinical and social needs before they escalate
• •Expert proficiency in post-discharge care coordination
• •Ability to reduce readmission risk
• •Ability to ensure safe care transitions
• •Ability to assess member clinical status through virtual encounters
• •Ability to identify changes in condition
• •Ability to triage urgency
• •Ability to escalate to the APC or RMO
• •Ability to conduct effective telehealth encounters
• •Ability to build member trust remotely
• •Ability to maintain engagement cadence for a complex, high-risk population
• •Advanced proficiency in Athena documentation
• •Ability to ensure all care coordination activities are documented accurately, completely, and within required timeframes
• •Ability to support HCC coding
• •Ability to support care continuity
• •Ability to support compliance with CMS and organizational standards
• •Ability to serve as the central coordination hub of a multi-disciplinary care pod
• •Ability to communicate clearly and proactively with APCs, Health Coaches, Care Coordinators, Social Workers, and the RMO
• •Working knowledge of HEDIS measures relevant to the Medicare Advantage population
• •Ability to identify and facilitate care gap closure activities
• •Active, unrestricted RN license in applicable state(s)
• •Ability to regularly talk or hear
• •Ability to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls
• •Ability to reach with hands and arms
• •Ability to frequently lift and/or move up to 10 pounds
• •Close vision
• •Ability to adjust focus

Desired Qualifications

• •Bilingual English/Spanish
• •BSN or higher from an accredited nursing program
• •Case Management Certification (CCM) or equivalent care management credential
• •Experience with Athena EMR
• •Experience with TalkDesk or equivalent virtual engagement platform
• •Background in population health
• •Background in care management programs
• •Background in complex case management for Medicare populations
• •Multi-state licensure
• •Formal training in motivational interviewing
• •Formal training in health coaching
• •Formal training in complex care management
• •HEDIS documentation and quality measure training
• •Transitions of care certification or equivalent training
• •ACLS certification