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Remote Rn Insurance Assessment Jobs in San Jose, CA

Madrona Hospice Care Inc.

Registered Nurse

San Jose, CA · Remote

$140 - $150/hr

Review OASIS assessments for completeness, appropriateness, and compliance with federal and state ... Valid driver's license, reliable insured vehicle. Nice to Have * OASIS certification (COS-C)

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All JobsRn Insurance Assessment JobsRemote Rn Insurance Assessment JobsRemote Rn Insurance Assessment Jobs in San Jose, CA

Remote Rn Insurance Assessment information

What are some common challenges faced by remote RN insurance assessment nurses, and how can they overcome them?

Remote RN Insurance Assessment nurses often encounter challenges such as managing a high volume of assessments, navigating various electronic health record systems, and ensuring thorough documentation while working independently. Effective time management, strong organizational skills, and ongoing communication with team members and supervisors are essential for success. Utilizing available training resources and participating in regular team meetings can also help nurses stay updated on best practices and maintain a collaborative work environment, even while working remotely.

What is a remote RN insurance assessment?

Remote RN Insurance Assessment jobs involve registered nurses working from home to assess patients' health status for insurance companies. These nurses review medical records, conduct telephonic or virtual health assessments, and document findings to help insurance companies make decisions on coverage, claims, or wellness programs. The role requires strong clinical knowledge, attention to detail, and excellent communication skills. It offers flexibility and the opportunity to use nursing expertise outside of traditional clinical settings.

What is the difference between Remote Rn Insurance Assessment vs Remote Rn Case Manager?

AspectRemote Rn Insurance AssessmentRemote Rn Case Manager
CredentialsRegistered Nurse (RN) license, insurance assessment certificationsRegistered Nurse (RN) license, case management certifications
Work EnvironmentRemote, primarily conducting assessments via phone or onlineRemote, coordinating patient care and services
Employer & IndustryInsurance companies, third-party administratorsHealthcare providers, insurance companies, managed care organizations

While both roles require an RN license and involve remote work, Remote Rn Insurance Assessment focuses on evaluating insurance claims and determining coverage eligibility. In contrast, Remote Rn Case Managers coordinate ongoing patient care, manage treatment plans, and liaise with healthcare providers. Understanding these differences helps professionals choose the role that best fits their skills and career goals.

What are the key skills and qualifications needed to thrive as a remote RN insurance assessment nurse?

To excel as a Remote RN Insurance Assessment Nurse, you need a current RN license, strong clinical assessment skills, and a thorough understanding of medical terminology and insurance protocols. Proficiency in telehealth platforms, electronic medical records (EMR), and insurance assessment tools such as MCG or InterQual is typically required. Exceptional communication, attention to detail, and the ability to work independently are crucial soft skills for this role. These competencies ensure accurate patient evaluations, effective remote collaboration, and compliance with insurance guidelines, ultimately leading to high-quality service and informed decision-making.
What cities near San Jose, CA are hiring for Remote Rn Insurance Assessment jobs? Cities near San Jose, CA with the most Remote Rn Insurance Assessment job openings:
Remote Rn Insurance Assessment jobs near you

Complex Case Manager (RN) - Temporary/Remote

Medix

Scotts Valley, CA • On-site, Remote

$56 - $64/hr

Full-time

Medical, Dental, Vision, Retirement

Re-posted 8 days ago

Job description

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Temporary Senior Complex Case Manager (RN)
Position Type: Temporary / Contract Assignment
Location: California-based (Remote / Hybrid with very rare office visits)
Schedule: Monday - Friday, 8:00 AM - 5:00 PM (1-hour lunch)
Compensation: $56-$64/hour
About the Role
Are you an experienced Registered Nurse looking for a high-impact, short-term project where you can truly leverage your clinical expertise? We are seeking a dedicated Temporary Senior Complex Case Manager (RN) to lead the development and management of comprehensive, member-centric care plans for our complex adult members.
This role offers a primarily remote work environment but requires candidates to reside in California and live within reasonable driving distance of one of our regional hubs for occasional, very rare in-office needs. Under direction, you will act as a vital clinical liaison and champion to promote optimal, cost-effective health outcomes while mentoring other staff on case management best practices.
What You'll Do (Responsibilities)
Care Plan Development & Case Management
  • Assess Complex Needs: Perform thorough clinical, physical, psychosocial, and functional assessments of complex adult members via phone, record reviews, or face-to-face.
  • Build Actionable Plans: Design, implement, and update individual care plans that identify and directly address health disparities, care gaps, and compliance barriers.
  • Lead Collaboration: Coordinate case conferences with multidisciplinary teams, facilitating smooth access to services, reducing avoidable hospital admissions, and aligning with Behavioral Health and Long-Term Services and Supports (LTSS).
  • Act as a Mentor: Share best practices and serve as a trusted clinical resource to support fellow case management staff.

Education & Community Collaboration
  • Empower Members: Educate members and caregivers on their customized care plans, healthcare benefits, and accessible community resources.
  • Streamline Transitions: Coordinate with network providers to ensure seamless transitions of care, accurate medication reconciliation, and robust follow-up services.
  • Advocate & Connect: Represent the organization at community meetings to advocate for quality care delivery.

Quality Improvement & Compliance
  • Drive Better Care: Participate in Quality Improvement studies focusing on care access, member education, and behavioral health outcomes.
  • Maintain Compliance: Monitor key performance indicators, audit case documentation for strict regulatory alignment, and assist with internal and external state audits.

What You Bring (Requirements)
  • Location & Residence: Must currently reside in California. Applicants must live within reasonable driving distance to at least one of the following locations for rare, occasional onsite commitments:
    • Scotts Valley, CA
    • Salinas, CA
    • Merced, CA
    • Mariposa, CA
  • Education: Associate's Degree in Nursing (ADN) or Bachelor's Degree in Nursing (BSN).
  • Licensure: Current, unrestricted license as a Registered Nurse (RN) issued by the State of California.
  • Experience: 5+ years of clinical RN experience, with a minimum of 3+ years specifically in case management.
  • Core Competencies: Exceptional clinical judgment and a strong, accurate documentation skill set.

Preferred Highlights (The Extras We'd Love)
  • Experience with Medicare, Medi-Cal, and/or D-SNP populations (Highly Preferred).
  • Background in hospital case management.
  • Working knowledge of D-SNP program regulations, including Medicare-Medi-Cal alignment, Model of Care (MOC) standards, and LTSS integration.
  • Familiarity or experience with Enhanced Care Management (ECM), Community Supports (CS), and/or LTSS coordination.
  • Bilingual skills (English/Spanish or English/Hmong).

Assignment Details & Work-Life Balance
  • Job Type: Temporary hourly contract assignment.
  • Predictable Schedule: Maintain a highly sustainable routine with a structured, daytime Monday through Friday, 8:00 AM to 5:00 PM schedule. No nights, weekends, or on-call rotations.
  • Scheduled break: Includes a dedicated, unpaid 1-hour lunch break every day.

Benefits
  • Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
  • Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
  • 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
  • Short Term Disability Insurance.
  • Term Life Insurance Plan.

* 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).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
* As a job position within our Care Management division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, access and handling of patient medical records, providing medical care inside a patient's residential address, driving, prescription and other drug access and administration, and working with vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. 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.
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About Medix Staffing Solutions

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Since 2001, we’ve been dedicated to helping you achieve your goals. Medix was created to become a leading provider of workforce solutions for clients and candidates across the healthcare and life sciences industries. Today, we are that leader. Headquartered in Chicago, we have 23 offices across the United States, and staff talent around the world. Medix is committed to fulfilling our core purpose as an organization: to positively impact the lives of our talent, clients, and teammates through employment, philanthropy, and opportunity. The combination of purpose and values has nurtured our thriving culture that encourages our internal team to excel at work and in everyday life.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

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