RN Health Plan Care Manager: Care Coordination & Utilization

Adventist Health; Antelope (MT); On-site; USD 80,000 - 100,000; Full time

Job summary

Adventist Health is seeking a Registered Nurse with case management experience to lead development, implementation and evaluation of cavitation care management service lines. The role focuses on whole-person in-patient and outpatient management, coordination with physicians, and cost-effective care planning within a health-plan context.

Preferred BSN, RN licensure in-state, and CCM certification. The ideal candidate will collaborate across departments to improve quality and optimize patient

Qualifications

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

Responsibilities

• Partners with internal and external physician advisors, claims and analytics teams to establish safeguards and outcomes for the Health Plan's member population.
• Collaborates with physicians, staff and service line leadership on quality and performance improvement activities related to efficient, high-quality care and resource utilization.
• Oversees discharge planning and utilization management to ensure medical necessity and care continuity.

Skills

Case management

Utilization review

Discharge planning

Quality improvement

Communication

Education

Bachelor's Degree in Nursing (BSN)

Nursing experience

Tools

EHR systems

Job description

Adventist Health is seeking a Registered Nurse with case management experience to lead development, implementation and evaluation of cavitation care management service lines. The role focuses on whole-person in-patient and outpatient management, coordination with physicians, and cost-effective care planning within a health-plan context.

Preferred BSN, RN licensure in-state, and CCM certification. The ideal candidate will collaborate across departments to improve quality and optimize patient