Senior Complex Case Manager Registered Nurse (RN) - Pediatric (Central Coast Area - Remote)
<div><strong>Role Overview</strong><br/><br/>Seeking a Senior Complex Case Manager Registered Nurse (RN) for a temporary project-focused assignment running through December 2026 (with potential extension into 2027). Instead of managing a traditional patient caseload, this role focuses on high-impact care integration projects, evaluating California Children's Services (CCS) medical eligibility against Title 22 standards, and facilitating critical referrals under the Whole Child Model.<br/> <br/>Equipment (laptop, monitor, headset) will be provided. While this role is fully remote, candidates must reside within a couple-hour driving distance of a regional office (Scotts Valley, Salinas, Merced, or Mariposa) for rare, occasional on-site needs.<br/> <br/><strong>Pay Rates</strong><br/> <ul> <li><strong>Zone 1 (Santa Cruz, Monterey, Bay Area, Sacramento, LA, San Diego):</strong> $49.00 - $63.00 / hour</li> <li><strong>Zone 2 (Merced, Mariposa, Central Valley, Fresno, San Luis Obispo):</strong> $46.00 - $59.00 / hour</li> </ul> <br/><strong>Key Responsibilities</strong><br/> <ul> <li>Execute project-based case management initiatives to support optimal health outcomes rather than maintaining a daily clinical caseload.</li> <li>Evaluate pediatric medical records and clinical diagnoses against Title 22 CCS eligibility requirements to ensure high-quality program admissions.</li> <li>Authorize outpatient and inpatient services while leveraging evidence-based criteria (MCG guidelines, CCS numbered letters).</li> <li>Collaborate directly with physicians, ancillary providers, and county agencies to streamline care integration under the Whole Child Model.</li> <li>Participate in Quality Improvement studies to measure program efficacy and promote cost-effective care standards.</li> </ul> <br/><strong>Required Qualifications</strong><br/> <ul> <li>Active, unrestricted Registered Nurse (RN) license issued by the State of California.</li> <li>Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN).</li> <li>5+ years of total RN experience, including at least 1+ year of dedicated Case Management experience.</li> <li>Minimum of 1 year of recent patient care experience in an acute or outpatient setting serving the assigned population (e.g., Pediatrics).</li> <li>Strong clinical judgment, quality review experience, and meticulous documentation skills.</li> </ul> <br/><strong>Preferred Qualifications</strong><br/> <ul> <li>Bachelor of Science in Nursing (BSN).</li> <li>Direct experience or knowledge of California's Whole Child Model (WCM) and Title 22 CCS regulations.</li> <li>Clinical background in Critical Care, Emergency Room, Telemetry, or Pediatrics.</li> <li>Nationally recognized Case Management certification (CCM or equivalent).</li> <li>Bilingual proficiency in English/Spanish or English/Hmong.</li> </ul> <br/><strong>Work Schedule</strong><br/> <ul> <li>Monday through Friday, 8:00 AM - 5:00 PM (Full-time, Temporary Contract)</li> </ul> </div>
