RN Care Manager: Health Plan & Care Coordination

Adventist Health; Rocklin (CA); On-site; USD 95,000 - 125,000; Full time

Job summary

Adventist Health Roseville and its shared service teams are seeking a Nurse Case Manager to lead the development, implementation, and evaluation of a cavitation care management service line. This role emphasizes whole person in-patient and out-patient management, care integration, and utilization review to promote continuity and cost-effectiveness.

Required RN licensure in the state of practice, with BSN and nursing experience preferred.

Qualifications

• BSN preferred.
• Nursing experience preferred.
• CCM certification preferred.
• RN licensure in the state of practice required.

Responsibilities

• Partner with physicians, claims, data management and analytics to provide safeguards and expected outcomes for the member population.
• Perform and coordinate preventative care, wellness, and nutritional counseling to Members.
• Develop and maintain positive relationships with customers internal and external.
• Collaborate with physicians, staff and service line leadership on quality and performance improvement activities related to optimal utilization of resources, efficient delivery of high quality care, patient flow, capacity management and other clinical cost reduction initiatives.
• Ensure medical necessity criteria are met and communicate changes that could affect the discharge plan of care.
• Manage communication related to discharge planning and utilization management.

Skills

Case management

Utilization review

Care planning

RN licensure

Nursing experience

Education

Bachelor's Degree in Nursing (BSN)

Job description

Adventist Health Roseville and its shared service teams are seeking a Nurse Case Manager to lead the development, implementation, and evaluation of a cavitation care management service line. This role emphasizes whole person in-patient and out-patient management, care integration, and utilization review to promote continuity and cost-effectiveness.

Required RN licensure in the state of practice, with BSN and nursing experience preferred.