Looking for a RN Case Manager to join our team in Sacramento!

Location: Hybrid – must be willing to travel up to 50 miles within the Greater Sacramento area during field days – mileage will be reimbursed

Schedule: Monday – Friday, day shift  

Job Summary: Under the direction and oversight of the Manager, Inpatient review and Case Management, the Senior Nurse Case Manager is

responsible and accountable for coordination of services for Medicare client members referred for complex case management. The Senior Nurse Case Manager coordinates all systems/services needed for an organized, multi-disciplinary, patient centered team approach, and cost-effective care for Medicare Client members. The Senior Nurse Case Manager follows and manages the course of treatment for patients while coordinating care with physicians, nurses, case managers and other staff to ensure quality care and safe outcomes. The Senior Nurse Case Manager also conducts initial and ongoing assessments, incorporates disease management protocols, ensures continuity of care through discharge planning and utilization of resources, and shifts cost to appropriate payers.

Responsibilities:

This level responds to more complex medical issues, serves as a subject matter expert to lower­ leveled nurses, and may participate in or lead intradepartmental teams, projects and initiatives.This level also serves as a proctor for new hires and participates in the training and/or retraining of lower-level nurses.Assists with development of care management policies and procedures, chairs and schedules meetings, as well as presents cases for discussion at Rounds/Care Conferences and participates in interdepartmental and/or cross brand workgroups.Partners with medical staff utilize scientific evidence for best practices, relevant data and compliance with the mission/philosophy, standards, goals and core values.Proactively assesses all potential case management identified from either external or internal sources and actively manages all high-risk, high-volume cases throughout the continuum of the member's health care needs or until they reach a maintenance mode.Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.Demonstrates a multidisciplinary approach in identifying problems, communication with the member's PCP, family members, caregivers, other members of the health care team, community resources and the Health Plans.Participates in the development of patient focused long/short term goals, implementing, evaluating and modifying the care plan.Research and refers members to sources for alternative funding, community services and other services which may provide support to the patient and family.Perform duties telephonically or on-site such as at hospitals, member home or provider offices for discharge planning. Primary duties may include but are not limited to: Ensures member access to services appropriate to their health needs.Identifies cases for possible peer reviewers to evaluate the appropriateness and necessity of care and or quality of care concerns.Assures referrals are complete and enrollment/eligibility benefits verified, prior to authorizing inpatient and outpatient care.Applies managed care techniques to clinical practice within established criteria.Provides instruction for members and their families; and serves as liaison between the member, the physician, the hospital and the Plan.May also refer to social workers, or other carve out services as neededCompletes appropriate, accurate and timely, documentation into EMR system every shiftExpected to provide meet all appropriate metrics.Provides ongoing evaluations of member needs and field nursing activities according to the standards, as well as the physicians.Assists in preparing UM/QI case issues, gathering requested records/responses.Possess knowledge of applicable regulatory standards and performs audits based upon these standardsAll other job-related duties relate to the job function or as delegated by the management team.Performs related duties consistent with the scope and intent of the position.Regular attendance.Travel as required.

Other Functions:

Enforces Company policies and safety procedures.Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.Maintain IPA, Health Plan compliance standards.

Pay and Benefits

The pay range for this position is $36.00 - $36.00/hr.

Eligibility requirements apply to some benefits and may depend on your job
classification and length of employment. Benefits are subject to change and may be
subject to specific elections, plan, or program terms. If eligible, the benefits
available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a fully onsite position in Sacramento,CA.

Application Deadline

This position is anticipated to close on Aug 2, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.