Case Manager – Transition of Care - Special Needs Plan (Must have California RN License)

RN Case Manager – Transitions of Care (SNP Focus) Location: Remote (California Required) Must have an active unexpired California RN license (LVNs not eligible) Employment Type: 100% Remote Schedule: Monday - Friday. 8am - 5pm PACIFIC STANDARD TIME

About the Role

We are hiring an experienced Registered Nurse (RN) Case Manager to support patients during critical transitions from hospital or skilled nursing settings back into the community. This role is heavily focused on managing members enrolled in Special Needs Plans (SNP)—including individuals with chronic illnesses, complex medical conditions, and dual eligibility. The ideal candidate brings a strong background in care coordination and thrives in a fast-paced, patient-centered environment where proactive outreach and thoughtful planning directly impact outcomes. What You’ll Do

• Lead post-discharge care coordination for high-risk patients, with a strong emphasis on SNP populations
• Create and implement individualized care plans addressing both clinical and social determinants of health
• Coordinate services across the continuum of care, including physicians, specialists, home health, and community programs
• Ensure timely referrals for services such as rehabilitation therapies, behavioral health, and social support resources
• Conduct follow-ups to assess patient progress and adjust care plans as needed
• Educate patients and caregivers on diagnoses, medications, and recovery expectations
• Serve as a key point of contact for patients navigating complex healthcare needs, especially within Special Needs Plans
• Identify gaps in care and intervene early to reduce readmissions and complications
• Connect patients to resources such as transportation, financial assistance, and community-based programs
• Document all care coordination activities in a timely and accurate manner
• Collaborate with interdisciplinary teams through case reviews and care discussions
• Support quality initiatives aimed at improving outcomes for high-risk and SNP members

What You Bring Experience:

• 2+ years of experience in case management, care coordination, or transitions of care
• Hands-on experience managing Special Needs Plan (SNP) populations strongly preferred
• Background working with Medicare Advantage or managed care models highly desirable

Education & Licensure:

• Active, unrestricted Registered Nurse (RN) license in California
• Willingness to obtain additional state licensure if needed (reimbursed by employer)
• Case Management certification (CCM or equivalent) is a plus

Core Competencies:

• Strong understanding of SNP models, Medicare guidelines, and care for complex/chronic populations
• Excellent communication skills with the ability to engage patients, families, and providers
• Highly organized with the ability to manage multiple cases simultaneously
• Critical thinking and problem-solving skills in dynamic environments
• Ability to interpret clinical data and apply it to care planning
• Comfortable working independently in a remote setting

Work Environment

• Fully remote role with standard business hours
• Primarily computer-based work with occasional phone outreach
• May require extended periods of sitting and light physical activity (up to 10 lbs)

Compensation & Benefits

• Competitive salary based on experience and qualifications
• Comprehensive benefits package (details provided during hiring process)

Equal Opportunity Employer We are committed to building a diverse and inclusive workforce. All qualified applicants will be considered without regard to protected characteristics. Job Type: Full-time Pay: $100,000.00 - $105,000.00 per year Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Referral program
• Retirement plan
• Vision insurance

Application Question(s):

• Do you have an active, unrestricted California Registered Nurse (RN) license?
• How many years of experience do you have in RN case management?
• Do you have direct experience working with Medicare Advantage populations?
• Do you have experience managing patients enrolled in Special Needs Plans (SNP), such as D-SNP, C-SNP, or I-SNP?
• Briefly describe your experience working with SNP populations and how you ensure compliance with CMS guidelines.

Language:

• Spanish (Preferred)

Work Location: Remote