RN Case Manager – Transition of Care, Bilingual Spanish

Alignment Health

. Ensure member access to services appropriate to their health needs .

Posted 10/16/2026full-timeRemote • United StatesMid-LevelSenior💰 $79,697 - $119,545 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive clinical case management experience, effective communication, and problem-solving skills while engaging with diverse members and healthcare providers. Proficient in implementing care plans and evaluating their effectiveness within a fast-paced environment.

Highest-signal resume keywords

Clinical Case Management ExperienceRN LicenseCare Plan ImplementationEffective Communication SkillsProblem Solving Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Care ManagementAuthorization ManagementIntervention MeasurementUtilization ReviewPatient Counseling

Soft Skills

LeadershipCollaborationOrganizational SkillsTime ManagementPositive Communication

Certifications & Qualifications

RN License

Industry Keywords

Healthcare ServicesPatient CareReimbursement NegotiationProvider RelationsClinical Assessment

About the role

Key responsibilities & impact

Ensure member access to services appropriate to their health needs
Identify, assess, and manage members per established criteria
Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements
Use independent judgment to determine authorization appropriateness and deploy internal and external resources to meet identified needs
Monitor and evaluate care management plan effectiveness and modify plans as necessary
Interface with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on care management treatment plans
Negotiate rates of reimbursement, as applicable
Assist with provider, claims, or service issue problem-solving
Measure intervention effectiveness to determine case management outcomes
Participate in and provide feedback on utilization and care management policies and procedures
Counsel and engage patients and families on available care options and help determine appropriate and preferred courses of action
Perform duties mostly telephonically

Requirements

What you’ll need

Minimum 5 years of clinical case management experience; or any combination of education and experience, which would provide an equivalent background
Associates or Bachelor's degree in Nursing
Current, unrestricted RN license in the state for which you are applying
Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors
Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment
Ability to meet the stated essential physical functions, including standing, walking, sitting, hand and finger use, reaching, talking, hearing, lifting and moving up to 10 pounds, close vision, and adjusting focus