Senior Complex Case Manager - Pediatric (RN) Defined Term

This is a Defined Term position, which is designated by the Alliance and is a position of limited duration. Defined Term employees are usually hired to work in a specific department on specific long-term project work until the work is completed or to a specific end date not to exceed December 31, 2026. This is a Defined Term and fully benefited position.

We have an opportunity to join the Alliance as a Senior Complex Case Manager - Pediatric (RN) on the Care Management team!

Reporting to the Complex Case Management Supervisor - Pediatric (RN), this position:

• Develops and manages an individualized comprehensive plan of care for members referred into the assigned Case Management Program with the goal of promoting optimal, achievable outcomes in the most cost effective and appropriate manner
• Works with and educates members, families, providers, external agencies and internal departments on the Case Management Program and provides assistance as needed
• Participants in Quality Improvement studies, to continually evaluate the program's effectiveness and ability in promoting quality driven, cost effective, achievable goals and outcomes for members
• Performs other duties as assigned

We look to support, connect, and empower members through community-based organizations and providers, in furtherance of improving health outcomes. The Care Management Team's mission is to coordinate care and empower members to achieve their health and wellness goals through collaboration and by facilitating member relationships with community providers. In Care Management, we serve the Alliance by creating a bridge between the Alliance, our communities, and individual members. We bring the voice of the member into the room when collaborating with our fellow departments at the Alliance and we assist the members in connecting the dots to successfully navigate options and resources for their care.

Pediatric Care Management:This unit is also about complex case management, but for our younger members. We work with the counties in line with California Children's Services Whole Child Model.

The ideal candidate is a flexible, team-oriented critical thinker who can work independently, navigate ambiguity, and collaborate when needed to support high-quality care for our pediatric members and families. They bring an active CA RN license, solid hospital or direct patient-care experience (pediatric and/or case-management preferred), and the ability to adapt to change while exercising good judgment and knowing when to seek support.

To read the full position description and list of requirements, click here.

• Knowledge of:
  
  
  
  • Thorough knowledge of the principles and practices of clinical nursing
  • Working knowledge of the principles and practices of case management
  • Working knowledge of care management and coordination
  • Working knowledge of evidence-based practice guidelines in the development of care plans
  
  
  
  
• Ability to:
  
  
  
  • Demonstrate strong critical thinking and problem-solving skills
  • Interpret and apply policies and regulations
  • Define issues, conduct research, interpret data, and identify and evaluate options
  • Evaluate medical records and other health care data
  • Organize work and manage complex priorities
  
  
  
  
• Education and Experience:
  
  
  
  • Current unrestricted license as a Registered Nurse issued by the State of California
  • Associate's degree in Nursing and a minimum of five years of experience in a patient care setting, including at least one year of case management experience a combination of education and relevant work experience may be qualifying
  • A minimum of one year of the required patient care experience must be in an acute or outpatient environment, working with the Pediatric population
  
  
  
  

• We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams.
• While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected.
• In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process.

The full compensation range for this position is listed by location below.

The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location).

Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area

Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area