Serene Health

Manager

• Serve as the RN of record for approximately 500 Enhanced Care Management members
• Provide clinical oversight and documentation review for care plans, assessments, and progress notes
• Respond to clinical escalations and ensure compliance with legal and payer guidelines
• Provide clinical sign-off on individualized whole-person care plans
• Collaborate with primary care, specialists, hospitals, behavioral health, and community agencies
• Monitor member progress and outcomes, adjust care plans, and ensure follow-up through remote documentation review and telehealth workflows
• Facilitate care transitions, discharge planning, follow-up appointments, and home-based care coordination
• Advocate for timely access to treatments, medications, and support services
• Review utilization patterns and design interventions to reduce avoidable hospital and emergency department visits
• Analyze payer and quality performance reports to identify care gaps and implement improvement strategies
• Train team members on quality improvement, safety, and case management best practices
• Maintain compliance with Medi-Cal, HEDIS, and quality standards while advancing health equity
• Perform additional duties as required

RN Case Manager