Case Manager

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POST DATE 8/24/2016
END DATE 12/19/2016

Alignment Healthcare Orange, CA

Orange, CA
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Job Classification
Full Time
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Exciting opportunity to work with advance technology in health care management and coordination within the scope of licensure for members with complex and chronic care needs by assessing, monitoring and optimizing member health care across the care continuum. Coordinates and monitors Alignment Healthcare member's progress and services to ensure consistent cost effective care that complies with Alignment policy and all state and federal regulations and guidelines. Performs duties mostly telephonically.



Monitor clinical alerts, triage patients' needs and follow the established decision tree.

Monitor home monitoring devices, assess patients' needs and follow up accordingly.

Ensures member access to services appropriate to their health needs.

Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners and specialists on the development of care management treatment plans.

Assists in problem solving with providers, claims or service issues.

Participates and provides feedback in the development of utilization/care management policies and procedures.

Counsels and engages in personal discussions with patients and their families on available care options. Helps them to determine their appropriate and preferred course of action





Minimum Experience:


5years of clinical case management experience; or any combination of education and experience, which would provide an equivalent background.


Requires a BA/BS in a health related field

Current, unrestricted RN license in the state for which you are applying


The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.