RN, Health Plan Care Manager

SupportFinity™; Roseville (CA); On-site; USD 130,000 - 170,000; Full time

Job summary

Adventist Health in Roseville, CA seeks a nursing leader to manage the development, implementation and evaluation of cavitation care management service lines, promoting continuity of care and cost effectiveness across inpatient and outpatient settings.

The role collaborates with physicians, claims and analytics to optimize resource use and discharge planning, requiring RN licensure and BSN preferred with CCM preferred.

Qualifications

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

Responsibilities

• Partners with physicians, claims, data management and analytics to provide safeguards and ensure outcomes for the member population.
• Performs preventative care, wellness and nutritional counseling for Members.
• Collaborates with service line leadership on quality and performance improvement for efficient care delivery and cost reduction.
• Ensures medical necessity criteria are met and communicates discharge plan changes.
• Manages discharge planning and utilization management communications.

Skills

Nurse leadership

Care coordination

Quality improvement

Communication

Education

BSN preferred

Job description

Job Description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary

Manages the development, implementation and evaluation of the cavitation care management service lines. Enhances the quality of member management by promoting continuity of care and cost effectiveness through whole person in-patient and out-patient management, care integration, case management, utilization review and care planning.

Job Requirements

Education and Work Experience:

• Bachelor's Degree in Nursing (BSN): Preferred
• Nursing experience: Preferred

Licenses/Certifications

• Certified Case Manager (CCM): Preferred
• Registered Nurse (RN) licensure in the state of practice: Required

Essential Functions

• Partners with internal and external physician advisors, as well as claims department and data management and analytics department to provide safeguards, processes and expected outcomes for the Health Plan's member population. Perform and/or coordinate preventative care, wellness, and nutritional counseling to Members. Develops and maintains positive relationships with customers internal and external.
• Works collaboratively 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.
• Performs ongoing collaboration with staff to ensure a member's medical condition meets medical necessity criteria. Communicates changes that could affect the discharge plan of care.
• Manages communication related to discharge planning and utilization management. Performs ongoing collaboration with staff to ensure condition meets medical necessity criteria.
• Performs other job-related duties as assigned.

Organizational Requirements

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

About Us

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.