Telephonic Case Manager

Job Description

Position Title: Telephonic Case Manager (Active California RN License Required)

Location: Remote / Hybrid (U.S.-Based)

Department: Clinical Operations / Case Management

Employment Type: Full-Time

Position Summary

We are seeking a dedicated and compassionate Telephonic Case Manager with an active California Registered Nurse (RN) license issued by the California Board of Registered Nursing (California BRN) . The Telephonic Case Manager will be responsible for coordinating patient care, conducting comprehensive assessments, developing care plans, and providing ongoing case management support through telephonic outreach.

The ideal candidate will possess strong clinical knowledge, excellent communication skills, and the ability to collaborate effectively with patients, healthcare providers, and interdisciplinary teams to improve health outcomes while ensuring compliance with applicable healthcare regulations and organizational standards.

Key Responsibilities

• Conduct comprehensive telephonic assessments to evaluate patients' medical, psychosocial, and healthcare needs.
• Develop, implement, and monitor individualized care plans based on clinical evaluations and established guidelines.
• Coordinate healthcare services among physicians, specialists, hospitals, rehabilitation facilities, and community resources.
• Provide patient education regarding diagnoses, treatment plans, medication adherence, preventive care, and available benefits.
• Identify barriers to care and implement strategies to improve patient engagement and treatment compliance.
• Monitor patient progress and adjust case management interventions as needed.
• Perform utilization review and resource coordination when applicable.
• Maintain accurate, timely, and compliant documentation in electronic medical records and case management systems.
• Collaborate with multidisciplinary teams to ensure quality care and achievement of clinical goals.
• Support cost-effective healthcare delivery while maintaining high standards of patient care.
• Ensure compliance with HIPAA, state and federal regulations, and company policies.

Required Qualifications

• Active and unrestricted Registered Nurse (RN) license issued by the California Board of Registered Nursing (California BRN).
• Minimum of 1 years of clinical nursing experience in case management, utilization management, disease management, workers' compensation, managed care, home health, or a related healthcare setting.
• Experience conducting telephonic patient assessments and care coordination.
• Strong knowledge of healthcare regulations, clinical guidelines, and care management principles.
• Proficiency with electronic medical records (EMR) and Microsoft Office applications.
• Excellent verbal and written communication skills.
• Ability to work independently in a remote environment while managing multiple priorities.

Preferred Qualifications

• Experience with Medicare, Medicaid, Managed Care, or Workers' Compensation populations.
• Bilingual English/Spanish preferred.
• Previous experience in telehealth or remote case management environments.