RN Health Plan Care Manager: Care Coordination

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

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.