RN Care Manager - Utilization & Care Coordination

Santa Barbara Cottage Hospital; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

Adventist Health Roseville seeks an experienced Registered Nurse with utilization review expertise to optimize patient care and resource use. The role emphasizes clinical review, collaboration with providers, and ensuring effective care transitions.

Ideal candidates hold an ADN with RN licensure, 5 years of acute hospital experience, and 2 years using Optum/InterQual for utilization review. The position is on-site in Roseville, CA with a focus on high-quality outcomes.

Qualifications

• ADN required to practice nursing.
• RN licensure in state of practice required.
• Minimum 5 years acute hospital experience required.
• Minimum 2 years utilization review experience using Optum/InterQual within last 12 months.

Responsibilities

• Reviews patient medical records to assess necessity and appropriateness of proposed treatments.
• Collaborates with healthcare providers and insurance companies to ensure seamless care and financial stewardship.
• Completes clinical reviews using Optum/InterQual to confirm right setting and length of stay.
• Meets productivity and quality audit metrics as defined by departmental goals.
• Communicates with care teams and other stakeholders to ensure coordinated care.

Skills

Utilization review

Clinical review

Communication skills

Collaboration

Education

ADN (Associate Degree in Nursing)

BSN (Preferred)

Tools

Optum/InterQual

Job description

Adventist Health Roseville seeks an experienced Registered Nurse with utilization review expertise to optimize patient care and resource use. The role emphasizes clinical review, collaboration with providers, and ensuring effective care transitions.

Ideal candidates hold an ADN with RN licensure, 5 years of acute hospital experience, and 2 years using Optum/InterQual for utilization review. The position is on-site in Roseville, CA with a focus on high-quality outcomes.