RN Health Plan Care Manager: Care Coordination

Adventist Health; Roseville (CA); On-site; USD 63,000 - 86,000; Full time

Job summary

Adventist Health in Roseville, CA, is seeking an experienced RN to oversee the development, implementation and evaluation of cavitation care management service lines, enhancing continuity of care and cost effectiveness across in-patient and out-patient settings.

The role emphasizes collaboration with physicians, the claims and data analytics teams, and service line leadership to improve utilization, discharge planning and patient flow.

Qualifications

• RN licensure in the state of practice is required.
• BSN preferred.

Responsibilities

• Collaborate with physician advisors, claims and data analytics to manage member population outcomes.
• Coordinate preventative care, wellness and nutritional counseling for Members.
• Lead quality and performance improvement activities to optimize resource use and care delivery.
• Assist in discharge planning and utilization management to ensure medical necessity criteria are met.
• Perform other job-related duties as assigned.

Skills

RN licensure

BSN

CCM

Education

Bachelor's Degree in Nursing (BSN)

Job description

Adventist Health in Roseville, CA, is seeking an experienced RN to oversee the development, implementation and evaluation of cavitation care management service lines, enhancing continuity of care and cost effectiveness across in-patient and out-patient settings.

The role emphasizes collaboration with physicians, the claims and data analytics teams, and service line leadership to improve utilization, discharge planning and patient flow.