Case Management Specialist RN

Case Management Specialist RN - Vascular Surgery

Job Summary

Works collaboratively with a panel of physicians to manage patients’ specialized needs. Duties include assessment, development of care management plans, coordination of interdisciplinary care, utilization management, transportation and transfer arrangements, cost‑effective measures, and patient education. An indirect caregiver who ensures paperwork is completed and works with the multidisciplinary team.

• Evaluate and identify members’ needs.
• Interface with primary care physicians, specialists, and various disciplines to develop case management plans/programs.
• Monitor and evaluate the effectiveness of the plans and modify as necessary.
• Coordinate the interdisciplinary approach to continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining authorizations for outside services.
• Act as a clinical liaison with outside agencies such as County CCS, non‑plan facilities, employers, workers’ compensation carriers, and third‑party administrators.
• Prepare reports, communicate program changes, and develop protocols in accordance with state regulations.
• Advocate and educate patients, ensuring they possess knowledge to manage their condition and are empowered to participate in their care plan.
• Develop individualized patient/family education plans focused on self‑management and deliver disease‑specific education.
• Create and update training materials and present them to staff, members, and families.
• Facilitate patients’ return to normal daily activities by making referrals for outside services or continued care.
• Consult with internal and external physicians, discharge planners, and outside agencies regarding continued care, hospitalization, or placement.
• Facilitate transportation and housing arrangements for patients when needed.
• Coordinate transmission of clinical and benefit information to patients, families, and outside agencies.
• Participate in data collection and analysis of clinical outcomes and customer satisfaction standards.
• Participate in formulation and implementation/monitoring of action strategies and outcomes of care or customer service.
• Maintain accurate records for each patient’s care.
• Interpret regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, and contract providers.

• Minimum of 2 years clinical experience as an RN in an acute or ambulatory care setting.

Education

• Bachelor’s degree in nursing or a related health field.
• Equivalent to 4 years of experience.

License, Certification, Registration

• Registered Nurse License (California).
• Basic Life Support certification.

• Ability to apply principles of utilization review, care coordination, transfer coordination, and discharge planning.
• Knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi‑Cal, etc.).
• Strong written and verbal communication, interpersonal, critical thinking, and problem‑solving skills.
• Computer literacy.

• Case Management Certification or specialty certification preferred.
• Bachelor’s degree in nursing or healthcare related field preferred.
• Experience in Vascular Surgery and knowledge of vascular access surgery.

Mid‑Senior level

Full‑time

Other