Health Plan Care Management Coordinator (OR)

Adventist Health • Portland, OR

5d

About The Position

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: Coordinates and provides utilization, disease and case management, and health coaching to health plan members. Applies substantial knowledge and experience to perform a wide range of advanced activities and/or determines how to use resources to meet schedules and goals; serves as working supervisor for team or work group.

Requirements

• High School Education/GED or equivalent
• Five years' related experience
• Registered Nurse (RN) license in state of practice

Nice To Haves

• Associate’s/Technical Degree or equivalent combination of education/related experience

Responsibilities

• Functions as liaison to members, providers, case coordinators, discharge planners, contracted health plans/partners and internal departments.
• Leads retrospective review process.
• Confirms orders utilizing established criteria.
• Enhances communication related to discharge planning and utilization management.
• Maintains effective communication with health care team members related to care coordination and utilization management.
• Performs ongoing collaboration with staff to ensure condition meets medical necessity criteria.
• 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.
• Ensures ongoing collaboration with staff to ensure condition meets medical necessity criteria.
• Communicates changes that could affect the discharge plan of care.
• Performs other job-related duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees