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Health Insurance Case Management Jobs in California

Forthright Case Management Llc

$90K - $110K/yr

Health insurance * Paid time off * Vision insurance We're Hiring! RN Case Manager (Bilingual - Spanish) - Southern California Location: Southern California (Hybrid - Part Remote, Part In-Person) Type ...

PIH Health

Case Management Coordinator

Whittier, CA · On-site

$23 - $36.70/hr

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million ... Experience in case management, managed care, or healthcare coordination * Spanish Speaking

PIH Health

Case Management Coordinator

Whittier, CA · On-site

The Inpatient Case Management Coordinator plays a critical role in supporting case managers and ... PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million ...

PIH Health

Case Management Coordinator

Whittier, CA · On-site

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million ... Experience in case management, managed care, or healthcare coordination * Spanish Speaking

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Health Insurance Case Management information

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How much do health insurance case management jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for health insurance case management in California is $24.43, according to ZipRecruiter salary data. Most workers in this role earn between $18.99 and $26.59 per hour, depending on experience, location, and employer.

What is health insurance case management?

Health insurance case management is a collaborative process where a case manager helps individuals with complex health needs navigate their insurance benefits and access appropriate medical care. Case managers work with patients, healthcare providers, and insurance companies to ensure that patients receive the necessary treatments while managing costs and adhering to policy guidelines. They may assist with coordinating care, authorizing services, and providing support during treatment or recovery. The goal is to improve health outcomes and enhance the efficiency of care delivery.

How does a health insurance case manager typically collaborate with healthcare providers and policyholders?

Health Insurance Case Managers regularly serve as liaisons between policyholders, healthcare providers, and insurance companies. They coordinate care by reviewing medical records, authorizing treatments, and ensuring that care plans align with coverage policies. Effective communication and problem-solving are essential, as they often work with doctors, nurses, and social workers to advocate for the patient’s best interests while managing costs. Regular team meetings and case conferences are common, providing opportunities to discuss complex cases and develop strategies for improved outcomes.

What are the key skills and qualifications needed to thrive as a health insurance case manager, and why are they important?

To thrive as a Health Insurance Case Manager, you need a background in healthcare or nursing, familiarity with insurance regulations, and strong analytical skills, often supported by a degree in health-related fields and certifications such as CCM (Certified Case Manager). Proficiency with case management software, claims processing systems, and electronic health records is typically required. Excellent communication, problem-solving, and organizational skills help in coordinating care and advocating for patients. These competencies are crucial to ensure effective care management, compliance, and optimal outcomes for both clients and insurers.

What is the difference between Health Insurance Case Management vs Health Insurance Claims Processing?

AspectHealth Insurance Case ManagementHealth Insurance Claims Processing
CredentialsCertifications like CCM or CHCM often preferredTypically no specific certifications required
Work EnvironmentCollaborative, patient-focused, often in healthcare or insurance officesAdministrative, data entry, and review in insurance companies or claims centers
Job FocusCoordinating patient care, managing complex cases, ensuring appropriate servicesReviewing, processing, and approving insurance claims for payment

Health Insurance Case Management involves coordinating patient care and managing complex cases, often requiring specialized certifications. In contrast, Health Insurance Claims Processing focuses on administrative review and approval of claims, with less emphasis on direct patient interaction. Both roles are essential in the insurance industry but serve different functions and require different skill sets.

Health Insurance Case Management jobs near you
Infographic showing various Health Insurance Case Management job openings in California as of August 2026, with employment types broken down into 1% As Needed, 74% Full Time, 18% Part Time, and 7% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $50,819 per year, or $24.4 per hour.

Case Management Nurse - ED - Per Diem Days

Torrance, CA • On-site

Torrance Memorial
Health Care and Social Assistance • 5 - 10K employees
Learn more about Torrance Memorialexternal

$70.62/hr

Other

Posted 10 days ago

Torrance Memorial Medical Center rating

7.8

Company rating: 7.8 out of 10

Based on 41 frontline employees who took The Breakroom Quiz

Job description

Case Management Nurse

Under supportive supervision, the Case Management Nurse supports the physician and interdisciplinary team in the provision of patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payers. The role integrates and coordinates utilization management, care facilitation, transitions of care, and discharge planning functions. The Case Management Nurse is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources.

Core Competencies

Adheres to policies, procedures, and standards of practice to deliver safe and optimal care Complies with Joint Commission's national patient safety goals Complies with organizational quality dashboard/benchmarking goals Maintains regulatory compliance consistent with quality standards and ethical obligations of the profession Participates in activities in alignment with the Magnet Model Participates in organizational committees, task forces and/or projects including presentation of project reports, committee recommendations, and task force activities at the unit level. Participates in Peer Review Participates in professional development activities Provides patient and family education throughout the care of patient Performs as a preceptor in an active and engaged manner Provides age specific and culturally competent discharge planning to all patients. Utilizes resources in an economical manner

Department Specific Competencies

Manages all aspects of discharge planning for assigned patients as follows: Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with the physician. Determines appropriate post-hospitalization facilities (home versus supervised living situation, board and care facility, extended –care facility, or rehabilitation facility), durable medical equipment, post-discharge nursing and/or therapist interventions, social service involvement, and need for assistance with activities of daily living. Interviews patients, family members and/or care givers, interface with responsible physicians, and reviews medical records. Identifies and resolves delays and obstacles in collaboration with the RN Case Managers, nursing and the attending physicians Attends interdisciplinary conferences/team meetings where appropriate to discuss patient's home situation, level of independence and activities of daily living, home management and environment, and anticipated discharge needs for continuum of care. Develops and maintains cooperative relationships with hospital personnel, physicians, suppliers and insurance case managers. Enters data including referral for managed care patients, into Home Health System. Monitors activity of observation cases to see that the patient is appropriately discharged in a timely manner.

Education

Associates - Nursing

License / Certification Requirements

Registered Nurse License BCLS or ACLS Certification

Compensation Range: $70.62 / Hour

What Torrance Memorial Medical Center employees say

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