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”

 

• Bachelor’s degree PLUS 2 years of experience in facilities management or property management required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. • 2 years of experience as an administrative assistant.