RN, Clinical Care Manager I

This position is intended to start January 2026.

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Gold Coast Health Plan (GCHP) RN, Clinical Care Manager I supports the GCHP mission to improve the health of the members through provision of the best possible quality care and services. As defined by the Case Management Society of America (CMSA): Care management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.

The RN, Clinical Care Manager I works closely with other team members and is a role model and resource to colleagues. This position acts as a bridge by facilitating communication between the member, member’s family and the providers. The RN, Clinical Care Manager I also provides member advocacy and education to maintain or improve clinical outcomes.

Amount of Travel Required:  5-10%

Work Schedule: Predominately remote work. Flexibility to work beyond normal business hours as needed.

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

•        Assess and identify members who may benefit from additional education, clinical support, and connecting them with appropriate medical providers.

•    Promote the most cost-effective healthcare delivery by coordinating with the medical management team.

•    Engage members into care coordination activities to reduce care gaps.

•    Evaluate for and work toward elimination of barriers to care.

•    Formulation of a member-centric care plan in partnership with the member.

•    Collaborate with internal partners including but not limited to; social workers, health education, pharmacy staff and          ECM/ Community Supports team, member services

•    Ensure confidentiality of utilization review, quality assurance information, and individual beneficiary identification

•    Assist with data collection for special member determination as required

•    Prepare written reports such as summaries of case management functions and updates of case status, use of covered services, supporting and reporting required metrics and other pertinent performance data, as directed

•    Provide accurate documentation to meet departmental policies, regulatory requirements and audits

•    Attend community meetings concerning health issues or provision of health-related services Establish and maintain effective working relationships with community resources and service agencies

•    Strong organizational, delegation and task prioritization skills

•    Member advocacy focus

•    Knowledge of required regulatory timelines to ensure department compliance with State contracts

•    Ability to convey empathy and is nonjudgmenta