Nurse Care Manager - Riverside/Los Angeles, CA

Outreach & Engagement

• Proactively reach out to assigned members through calls, field visits, and community engagement to build trust and encourage ECM participation.
• Establish strong rapport with members using motivational interviewing and trauma-informed approaches.

Assessment & Care Planning

• Complete comprehensive assessments covering medical, behavioral health, and social needs.
• Develop individualized SMART care plans in collaboration with members, setting achievable goals for improved health and stability.
• Review and update care plans regularly to reflect member progress and needs.

Care Coordination & Navigation

• Coordinate medical care and follow-up appointments to reduce gaps in treatment and avoid unnecessary emergency room visits.
• Work with hospitals, clinics, and primary care providers to ensure safe and effective transitions of care after hospital discharge, preventing readmissions.
• Connect members to community-based resources such as housing, food security programs, transportation, behavioral health services, and other social supports.

Documentation & Compliance

• Enter all contacts, interventions, and care plan updates into EMR systems (eClinicalWorks experience a plus).
• Maintain clear, accurate, and timely documentation that meets Medi-Cal and Managed Care Plan audit standards.
• Health Promotion & Member Advocacy
• Educate members on preventive health measures and encourage them to participate in both primary and specialty care.
• Advocate for members by coordinating services across healthcare providers, social agencies, and Managed Care Plans.

Requirements

Education & Background

• Prior experience in a healthcare setting (doctor’s office, hospital, or clinic) required.
• Familiarity with eligibility, authorizations, and referrals is essential.
• Graduate of a healthcare vocational program (e.g., 4D College, UEI, or equivalent).
• Previous roles may include: Medical Assistant, Referral Coordinator, Care Coordinator, Community Health Worker, Patient Navigator, LVN.

Core Competencies

• Skilled in motivational interviewing, member engagement, and rapport-building with diverse populations.
• Highly organized and disciplined in caseload management and documentation.
• Effective communicator across interdisciplinary care teams and community partners.
• Flexible problem-solver with experience addressing housing, food insecurity, transportation, chronic disease, and behavioral health needs.
• Mission-driven to serve underserved communities and reduce health disparities.
• Motivated by performance-based incentives tied to compliance, quality, and member outcomes.
• Committed to culturally responsive care, trauma-informed practices, and collaborative teamwork.
• Health Insurance: Medical, dental, vision insurance and 401(k)

Benefits

Benefits

• Paid Time Off: Sick time, paid holidays, and vacation time to support work-life balance.
• Compensation and Incentives: Competitive salary with annual merit increases and quarterly bonus opportunities.
• Flexibility: Work-from-home options for several days a week.
• Professional Growth: Opportunities for career advancement and continued professional development.
• Career Development: Opportunities for career advancement and professional development