The Ambulatory Case Manager, RN is responsible for providing comprehensive care coordination and case management services to members, ensuring seamless transitions of care, promoting health stabilization, and reducing avoidable hospitalizations. The PHP Ambulatory Case Management team is responsible for High-Risk Case Management, Complex Case Management (CCM), Special Needs Plan Case Management (SNP) and Care Coordination including Transitions of Care. This role requires strong knowledge of case management programs, health plan benefits, managed care principles, and community resources. Will engage with members, families, healthcare providers, and multidisciplinary teams to create and implement individualized care plans. Serves as a liaison between key stakeholders including members, providers, and health plans.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3.7 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 35 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women's health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation's top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Strong knowledge of case management principles, care coordination, and transition of care processes
• Understanding of managed care, including risk-based contracts, delegated health plans, and compliance requirements
• Ability to work collaboratively with multidisciplinary teams, patients, and families
• Strong communication, organizational, and problem-solving skills
• Computer literate, with ability to navigate multiple computer applications

Required Experience

• Associate degree
• Current California State RN licensure
• Minimum 2 years clinical experience

Preferred:

• Bachelor's Degree
• Valid California Driver's License and proof of automobile insurance
• Experience in case management.
• Managed Care experience
• Proficiency in Word and Excel