RN Health Plan Care Manager: Care Coordination & Outcomes

Talented Medical Solutions; Roseville (CA); On-site; USD 95,000 - 130,000; Full time

Job summary

Talented Medical Solutions seeks an RN Health Plan Care Manager to oversee development, implementation, and evaluation of care management services for plan members. The role emphasizes care integration, utilization review, discharge planning, and cost-conscious care planning.

Preferred candidates hold a BSN and RN licensure with CCM as a bonus, focusing on collaboration with physicians and care teams to promote high-quality, cost-effective outcomes.

Qualifications

• Bachelor's Degree in Nursing preferred.
• RN licensure in state of practice required.
• Certified Case Manager (CCM) preferred.
• Nursing experience preferred.

Responsibilities

• Coordinates care management services for Health Plan members.
• Partners with physicians, claims, and data management teams to support member care.
• Coordinates preventative care, wellness, and nutritional counseling.
• Collaborates on quality improvement, resource utilization, and cost reduction initiatives.
• Reviews member conditions for medical necessity criteria.
• Manages discharge planning and utilization management communication.
• Maintains positive relationships with internal and external customers.
• Performs other job-related duties as assigned.

Skills

Care management

Utilization management

Discharge planning

Communication

Education

BSN (Preferred)

Nursing experience (Preferred)

Job description

Talented Medical Solutions seeks an RN Health Plan Care Manager to oversee development, implementation, and evaluation of care management services for plan members. The role emphasizes care integration, utilization review, discharge planning, and cost-conscious care planning.

Preferred candidates hold a BSN and RN licensure with CCM as a bonus, focusing on collaboration with physicians and care teams to promote high-quality, cost-effective outcomes.