RN, Health Plan Care Manager

Job Summary

RN, Health Plan Care Manager

Talented Medical Solutions

Contract

In-Office | Roseville, CA, United States

Day Shift - On-site in Portland. 40 hrs a week, M-F, RN licensure required. Case Management certification preferred; 5-10 years of acute and ancillary experience in multiple modalities. Preferred experience working in a health plan on utilization management and case management activities. Candidates need to have strong communication skills and experience coaching patients/members through their healthcare journey.

Located in the metropolitan area of Sacramento, the 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. Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Manages the development, implementation and evaluation of the cavitation care management service lines.

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.

Job Requirements:

Education and Work Experience: Bachelor's Degree in Nursing (BSN): Preferred

Nursing experience: Preferred

Licenses/Certifications: Certified Case Manager (CCM): Preferred

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.

Perform and/or coordinate preventative care, wellness, and nutritional counseling to Members.

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.

Performs ongoing collaboration with staff to ensure a member's medical condition meets medical necessity criteria. 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.

Performs other job-related duties as assigned.

Organizational Requirements:

Our facility 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.