RN Health Plan Care Navigator

Talented-Medical-Solutions; Roseville (CA); On-site; USD 95,000 - 125,000; Full time

Job summary

Talented-Medical-Solutions in California is seeking an RN Health Plan Care Manager to lead the development, implementation, and evaluation of care management services. You will promote continuity of care, manage case management, utilization review, and care planning while collaborating with physicians, claims, and data teams to support member care.

This role emphasizes cost effectiveness, quality improvement, and discharge planning, with a focus on maintaining positive relationships with

Qualifications

• RN licensure in state of practice is required.
• BSN degree 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.

Education

BSN (Preferred)

Nursing experience (Preferred)

Job description

Talented-Medical-Solutions in California is seeking an RN Health Plan Care Manager to lead the development, implementation, and evaluation of care management services. You will promote continuity of care, manage case management, utilization review, and care planning while collaborating with physicians, claims, and data teams to support member care.

This role emphasizes cost effectiveness, quality improvement, and discharge planning, with a focus on maintaining positive relationships with