Manager Cigna Rn Remote Jobs in Oakland, CA (NOW HIRING)

Location: Fully Remote - California
Schedule: Monday-Friday, 8:00/8:30 AM-5:00/5:30 PM PST
Hours: 40 hours per week
Position Type: Remote

We are seeking a California-licensed Registered Nurse (RN) to serve as the clinical lead for a focused compliance project supporting Special Needs Plan (SNP) members. This role will be responsible for comprehensive clinical case reviews, member assessments, individualized care plans, and ensuring documentation meets CMS regulatory and quality standards.

The RN will also provide clinical oversight and direction to LVNs while collaborating with care coordination leadership and interdisciplinary care team members. Daily productivity will be monitored, and the RN will be expected to consistently meet regulatory timelines and quality standards.

• Complete comprehensive clinical case reviews for assigned SNP members.
• Conduct clinical assessments and validate members' clinical needs.
• Finalize and approve Individualized Care Plans (ICPs) prepared in collaboration with LVNs.
• Review, enhance, and ensure accuracy of LVN-prepared SBARs for Interdisciplinary Care Team (ICT) meetings.
• Provide clinical oversight, direction, and support to LVNs.
• Delegate appropriate tasks to LVNs based on clinical needs and scope of practice.
• Ensure all clinical documentation is accurate, complete, and compliant with CMS requirements.
• Identify gaps in care and appropriately escalate clinical concerns or issues.
• Collaborate with care coordination leadership and interdisciplinary partners.
• Ensure work is completed within required regulatory timelines.
• Maintain high standards of clinical quality, documentation accuracy, and productivity.

• Current California RN license in good standing.
• Minimum of 2 years of nursing experience.
• Strong clinical judgment and assessment skills.
• Excellent documentation and communication skills.
• Ability to work independently in a fully remote environment.
• Strong organizational skills and ability to manage multiple clinical cases and deadlines.

• 2+ years of experience in care management, case management, utilization management, or a related field.
• Understanding of DSNP regulatory requirements.
• Previous experience supervising or providing clinical oversight to LVNs.
• Experience with individualized care plans, SBARs, and interdisciplinary care teams.
• Experience working with CMS compliance requirements.

• Monday-Friday
• 8:00 AM or 8:30 AM - 5:00 PM or 5:30 PM PST
• 40 hours per week / 8 hours per day
• Fully remote throughout California

• Fully remote opportunity available throughout California.
• Monday-Friday schedule with no weekends required.
• Opportunity to take on a clinical leadership role supporting a focused compliance initiative.
• Client-provided equipment.
• Collaborative environment working alongside LVNs, care coordination leadership, and interdisciplinary teams.

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.

Here at Medix, we are dedicated to providing workforce solutions to clients throughout multiple industries. We have been named among the Best and Brightest Companies to Work For in the Nation for two consecutive years. Medix has also been ranked as one of the fastest growing companies by Inc. Magazine.

Our commitment to our core purpose of positively impacting 20,000 lives affects not only the way we interact with our clients and talent, but also with our co-workers! The goal is lofty, but it is made attainable through the hard work and dedication of our teams and their willingness to lock arms together. Are you ready to lock arms with us?