About the position A managed care organization serving California Medicaid members is seeking an experienced and compassionate Registered Nurse (RN) to join its Care Management team in a fully remote capacity. This position is responsible for coordinating and facilitating admissions to long-term care and rehabilitation facilities for members requiring skilled or extended care services. The ideal candidate will have a background in home health, senior living intake, or long-term care admissions, along with a strong understanding of Medicaid eligibility, coverage, and placement protocols.

Responsibilities

• Coordinate and oversee admissions and transitions of care for members entering long-term care, skilled nursing facilities (SNFs), or subacute rehabilitation settings.
• Independently review clinical documentation and assessments to determine appropriate placement based on member needs and California Medicaid guidelines.
• Serve as the primary liaison between the health plan, facility admissions teams, discharge planners, and providers to ensure smooth and timely placements.
• Manage prior authorization processes, approve services within scope, and confirm Medicaid eligibility.
• Collaborate with Utilization Management and Case Management teams to support continuity of care and efficient resource utilization.
• Provide education to members and families regarding benefits, services, and expectations during care transitions.
• Maintain accurate, detailed documentation in EMR and care management systems.
• Ensure compliance with all state regulations, HIPAA requirements, and internal quality standards.

Requirements

• Active, unrestricted RN license in the State of CA (required).
• Minimum of 3 years of clinical experience in home health, long-term care, rehabilitation, or admissions/intake coordination.
• Strong knowledge of California Medicaid systems, authorizations, and coverage criteria.
• Excellent communication, critical thinking, and documentation skills.
• Proficiency with electronic medical records (EMR) and care coordination software.
• Ability to work independently and remotely in a fast-paced environment.

Nice-to-haves

• Managed care, health plan, or insurance case management background.
• Experience in discharge planning, transitional care, or post-acute navigation.
• Bilingual English/Spanish is a plus but not required.

Benefits

• Competitive compensation
• full benefits package
• 401(k) with match
• generous paid time off
• continuing education support
• remote work flexibility