Medical Case Manager

Job Description Job Title:

Medical Case Manager Department:

Case Management Work Arrangement:

Full Office Work Schedule:

Monday through Friday, 8:00 a.m. – 5:00 p.m.

Position Summary One of our client is seeking a dedicated and experienced

Medical Case Manager

to support comprehensive care coordination and case management services. This role is responsible for assessing member needs, developing individualized care plans, coordinating services across the continuum of care, and advocating for optimal health outcomes. The Medical Case Manager will work collaboratively with members, caregivers, providers, and interdisciplinary teams to ensure high-quality, member-centered care. Duties & Responsibilities Care Management (85%) Conducts standardized health needs assessments and health risk assessments to identify member needs. Performs comprehensive, disease-specific clinical assessments, including evaluation of: Physical, functional, social, and psychological status Cultural and linguistic needs Caregiver resources and available benefits Completes post-discharge assessments following hospital or emergency department stays to identify ongoing care needs, including: Follow-up provider care and appointment coordination Durable medical equipment (DME) and medical supplies Community resources and support services Develops, implements, and manages individualized care plans using

SMART goals

(Specific, Measurable, Achievable, Relevant, Time-Bound). Reviews, updates, and modifies care plans continuously, at minimum annually or upon change in condition. Schedules and conducts follow-ups to assess progress toward goals and identify barriers to care. Provides regular outreach to assigned members and members on worklists, ensuring compliance with departmental contact standards. Coordinates care and services with members, family members or representatives, healthcare providers, community supports, and Long-Term Services and Supports (LTSS). Communicates effectively with physicians, specialists, community agencies, and vendors to ensure seamless service delivery. Facilitates referrals to behavioral health and substance use disorder services, LTSS departments, and community resources. Facilitates and participates in interdisciplinary team meetings as required. Collaborates with interdepartmental teams to resolve complex cases. Identifies cases requiring escalation to supervisors, managers, directors, or medical directors and follows appropriate routing and closure procedures. Advocates for members by securing necessary funding, treatment alternatives, timely services, and ongoing evaluation of outcomes. Administrative Support (10%) Supports a mission-driven culture emphasizing quality performance, customer service, dignity, accountability, and consistency. Assists the team in achieving departmental short- and long-term goals. Documents all case management interventions in accordance with organizational protocols. Prepares and maintains accurate, timely documentation of patient care and progress within care plans. Other Duties (5%) Completes additional projects and responsibilities as assigned. Minimum Qualifications Associate Degree in Nursing (ADN) or related field

required , plus

three (3) years of clinical and/or managed care experience , OR

an equivalent combination of education and experience sufficient to perform the essential duties. Bilingual in English and Spanish

(required; threshold language). Preferred Qualifications Bachelor of Science in Nursing (BSN) or related field. Case Management Certification (CCM). Required Licensure / Certifications Current, unrestricted

Registered Nurse (RN)

license to practice in the state of

California . Knowledge, Skills & Abilities Ability to establish and maintain effective working relationships with leadership, staff, and external partners from diverse backgrounds. Strong independent judgment and decision-making skills. Excellent verbal and written communication skills. Ability to work flexible schedules, including evenings and weekends as needed. Strong organizational, analytical, problem-solving, and project management skills. Ability to manage multiple priorities in a fast-paced environment. Demonstrated ability to motivate and lead multi-program teams and external committees. Proficiency with Microsoft Office applications (Word, Outlook, Excel, PowerPoint) and job-specific systems. Physical Requirements (With or Without Accommodations) Ability to read from computer screens, printed materials, and forms. Clear verbal communication and adequate hearing for phone and in-person interactions. Manual dexterity for typing, writing, standing, reaching, bending, crouching, kneeling, walking, and prolonged sitting. Ability to lift and move objects, patients, or equipment weighing

10–25 pounds . Work Environment Office or Remote Location: Indoor, sedentary work environment with potential travel as needed. Moderate noise levels; no harmful environmental conditions. Clinical indoor setting serving frail and elderly populations. Potential exposure to hazardous conditions; moderate to loud noise levels. Community-Based Work: Combination of indoor sedentary work and occasional outdoor activities in varying temperatures. Potential exposure to hazardous conditions; moderate to loud noise levels.