Adventist Health

Faith-based nonprofit integrated health system

Health Plan Care Management Manager - RN Required

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours

Full-timeRoseville, CA, USAIn-person

About the Job

Requirements

A bachelor's degree in nursing or an equivalent combination of education and related experience is required.
Registered Nurse licensure in the state of practice is required.
A master's degree is preferred.
Five years of nursing experience is preferred.
One year of leadership experience in a physician clinic, hospital department, or health plan setting is preferred.
Certified Case Manager designation is preferred.
All required vaccinations must be received as a condition of employment and annually thereafter where applicable.
Participation in E-Verify requires acknowledgment of the E-Verify Participation and Right to Work notices.

Responsibilities

Develop, implement, and evaluate services provided by the care management department.
Enhance member management quality through continuity of care and cost-effectiveness initiatives, including whole-person inpatient and outpatient management, care integration, case management, utilization review, and care planning.
Supervise and direct the activities of assigned personnel using professional and supervisory discretion and independent judgment.
Partner with internal and external physician advisors, the claims department, and the data management and analytics department to establish safeguards, processes, and expected outcomes for the health plan member population.
Provide formal and informal education to physicians and the care management team to improve processes and outcomes related to utilization review, case management, and compliance.
Develop and maintain positive relationships with internal and external customers.
Collaborate with physicians, staff, and service line leadership on quality and performance improvement activities related to resource utilization, high-quality care delivery, patient flow, capacity management, and clinical cost-reduction initiatives.
Communicate changes that could affect the discharge plan of care.
Manage communication related to discharge planning and utilization management.
Collaborate continuously with staff to ensure that conditions meet medical-necessity criteria.
Recruit, train, coach, supervise, and responsibly direct assigned staff.
Perform other job-related duties as assigned.

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Develops, implements and evaluates the services provided by care management department. Enhances the quality of member management by promoting continuity of care and cost effectiveness through whole person in-patient and out-patient management, care integration, case management, utilization review and care planning. Supervises and directs the activities of various levels of assigned personnel using both professional and supervisory discretion and independent judgment.

Job Requirements:

Education and Work Experience:

Bachelor’s Degree in nursing or equivalent combination of education/related experience: Required
Master's Degree: Preferred
Five years' nursing experience: Preferred
One year's leadership experience in a physician clinic, hospital department or health plan setting: Preferred
Certified Case Manager: Preferred

Licenses/Certifications:

Registered Nurse (RN) licensure in the state of practice: Required

Essential Functions:

Partners with internal and external physician advisors, as well as claims department and data management and analytics department to provide safeguards, processes and expected outcomes for the Health Plan's member population. Provides formal and informal education to physicians and the care management team to improve processes and outcomes related to utilization review, case management and compliance. Develops and maintains positive relationships with customers internal and external.
Works collaboratively with physicians, staff and service line leadership on quality and performance improvement activities related to optimal utilization of resources, efficient delivery of high quality care, patient flow, capacity management and other clinical cost reduction initiatives. Communicates changes that could affect the discharge plan of care.
Manages communication related to discharge planning and utilization management. Performs ongoing collaboration with staff to ensure condition meets medical necessity criteria.
Exercises independent judgment in recruiting, training, coaching, supervising and responsibly directing assigned staff.
Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Pay Range: The estimated base pay for this position is $126,080 to $189,121. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information.

About the Company

Adventist Health

Faith-based nonprofit integrated health system

Adventist Health is a faith-based nonprofit health system with more than 400 sites of care, including 26 acute care hospitals, primarily on the West Coast and in Hawaii. It provides a full range of health services—from primary and specialty care to hospital-based treatments and wellness programs—delivered across an integrated network of clinics, hospitals, and care facilities. Revenue comes from patient services, insurance reimbursements, and government programs, and earnings are reinvested back into communities to improve health outcomes and expand access to care. The organization differentiates itself through its nonprofit, faith-based model and by reinvesting earnings into community health, along with its broad, integrated network that covers preventive, primary, specialty, and acute care. Its goal is to improve health outcomes for the communities it serves and to expand access to high-quality care.

Company size: 10,001+
Company stage: Grant
Total funding: $210K
Headquarters: Roseville, CA
Founded: Not listed

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