RN - Medical Case Manager - Sunshine Enterprise USA LLC

RN – Medical Case Manager

Company Overview: Our client is a leading healthcare located in Orange, CA, seeking a medical case manager, who will be responsible for providing intensive case management, which includes assessment, planning, implementation, coordination, monitoring and evaluation of the member’s needs.

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:

• Conducts standardized health and risk assessments for members.
• Performs comprehensive, disease-specific assessments, evaluating physical, functional, social, and psychological status, cultural and linguistic needs, caregiver resources, and available benefits.
• Conducts post-discharge assessments to address post-hospital or emergency discharge needs, including:
  1. Member’s status (physical, functional, social, psychological)
  2. Cultural and linguistic needs
  3. Caregiver resources and available benefits
  4. Follow-up care, scheduled appointments, durable medical equipment, and community resources
• Develops and implements a personalized care plan with SMART goals.
• Reviews and updates care plans regularly, at minimum annually or with any change in condition.
• Schedules follow-ups to track progress, addresses goal barriers, and provides regular outreach to assigned members per contact standards.
• Coordinates care with members, their families, and other providers, including community and LTSS resources.
• Communicates with physicians, specialists, agencies, and vendors to ensure service coordination.
• Facilitates referrals to behavioral health/substance use services, LTSS, and community resources.
• Participates in Interdisciplinary Team meetings and collaborates in case resolution as needed.
• Escalates cases for supervisor, manager, or medical director review as required, and closes cases promptly.

• Advocates for necessary funding, treatment options, timelines, and coordinated care, ensuring progress evaluations align with goals.
• 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 managed care, case management and post-discharge and assessing the needs.
• 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”