Medical Case Manager (RN) Long Term Care - Sunshine Enterprise USA LLC

Medical Case Manager RN Long Term Care

Company Overview: Our client is a leading healthcare located in Orange, CA, seeking a medical case manager for the long-term care department, where they utilize advanced specialty collaborative practice, responsible for case management, care coordination, authorization and utilization management of the assigned population of focus

Position Summary: The successful candidate should hold a current, unrestricted registered nurse (RN) license to practice in the state of California, holds a bachelor’s degree in nursing, and has 3 years of clinical experience.

Work Duration: Up to 6 months

Work hours: 8 am – 5 pm, M-F

Position Responsibilities:

• Utilize case management processes, including assessment, care planning, implementation, and monitoring to support member health.
• Conduct and review clinical assessments using standardized tools (e.g., PASRR, MDS, CEDT, HRA).
• Collaborate with hospitals on discharge planning, participate in rounds, and coordinate with CalAIM providers for community support services.
• Document case activities accurately and ensure timely data entry for authorizations and care updates.
• Review service requests against medical criteria and regulatory guidelines, escalating complex cases to the Medical Director as needed.
• Engage with patients, families, and physicians to assess care needs and explain CalAIM and case management resources.
• Identify high-cost, complex cases for intensive case management and perform regular progress assessments to optimize care plans.
• Develop and oversee member care plans with input from the interdisciplinary team, adapting as necessary to improve outcomes.
• Communicate with CalAIM providers, community agencies, and other partners to coordinate comprehensive patient care.
• Advocate for member needs, including securing resources, alternative treatments, and timely care delivery.
• Document case decisions and actions in the medical management system and evaluate progress toward case management goals.
• Participates in hospital rounds.
• Complete additional assignments and projects as assigned.

Experience & Education:

• Current, unrestricted RN license to practice in the state of California required.
• Bachelor’s degree in nursing (BSN) required
• 3 years of clinical experience with the health needs of the population served required.
• 2 years of experience in Long Term Care, Community Health, Managed Care Medi-Cal, Medicare programs highly preferred
• Active Commission for Case Manager (CCM) certification preferred

Necessary Attributes:

• Establish effective relationships with internal and external stakeholders.
• Demonstrate independent judgment and decision-making skills.
• Communicate effectively both verbally and in writing.
• Flexible schedule availability for evening and weekend events.
• Strong organizational, analytical, and problem-solving abilities.
• Proficiency in Microsoft Office (Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.

Please see HR for information on physical demands and work environment of this job.

Sunshine Enterprise USA is an “Equal Opportunity Employer—Minorities, Females, Veterans and Disabled Persons”