RN, Health Plan Care Manager

Job Description

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.

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.

Education and

Work Experience:

• Bachelor's Degree in Nursing (BSN):
  Preferred
• Nursing experience:
  Preferred

• Certified Case Manager (CCM):
  Preferred
• Registered Nurse (RN) licensure in the state of practice:
  Required

• Partners with internal and external physician advisors, claims department, data management and analytics departments to provide safeguards, processes and expected outcomes for the Health Plan’s member population. Performs and/or coordinates preventative care, wellness, and nutritional counseling for members. Develops and maintains positive relationships with internal and external customers.
• 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 and 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.

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.

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Adventist Health is a faith‑based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God’s love by inspiring health, wholeness and hope.