Care Manager, Transition of Care (RN)

Perform care management for post-discharge members, assessing, planning, and coordinating medical and supporting services across the continuum of care. Complete medication reconciliation between pre-admit and post-discharge medications. Conduct post-discharge assessments for members transitioning from healthcare facilities and develop care/service plans in collaboration with discharge planners, providers, specialists, and interdisciplinary teams. Assess member health status, resource needs, and treatment plans, providing appropriate interventions and facilitating transition into active care management. Provide education and resource materials to members, caregivers, and providers, and coordinate services between PCPs, specialists, and non-medical community resources to address medical and socioeconomic needs. Outreach is performed telephonically, digitally, or via home/site visits as needed. Document all member information and care management activities in compliance with state, federal, and payer regulations. Candidate must reside in California and hold an active California RN license (or qualifying behavioral health license). Requires a degree from an accredited school of nursing (or Master's in Behavioral Health/Social Work) plus 2–4 years of related experience. Pay range: $27.02–$48.55/hour.