RN Health Plan Case Manager
About The Position
Reporting to the Director CVHP Operations, CVHP Operations, this position coordinates care and service for defined patient populations across the acute care continuum for CVHP members. This includes discharge planning, utilization management, care coordination, and support for resource utilization. This position works collaboratively with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources. The incumbent makes significant contributions toward achievement of desired clinical, financial, and resource utilization outcomes.
Requirements
- High school diploma or equivalent is required. A degree from an accredited baccalaureate nursing program is preferred.
- Current licensure as a Registered Nurse in the state of California is required.
- Current American Heart Association (AHA) Healthcare Provider CPR card is required.
- CCM national certification is preferred.
- Experience with two (2) areas of clinical specialty is preferred.
- Excellent communication skills, critical thinking, creative problem-solving skills, and competent organizational and planning skills are required.
- Ability to be self-directed and tolerate frequent interruptions while managing a demanding workload is required.
- Knowledge regarding hospital protocol and procedures, clinical standards and outcomes, funding options, familiarity with community resources and outside professional agencies, familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial structure of health plan and delivery system is preferred.
Nice To Haves
- A degree from an accredited baccalaureate nursing program
- CCM national certification
- Experience with two (2) areas of clinical specialty
- Knowledge regarding hospital protocol and procedures, clinical standards and outcomes, funding options, familiarity with community resources and outside professional agencies, familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial structure of health plan and delivery system
Responsibilities
- Coordinates care and service for defined patient populations
- Discharge planning
- Utilization management
- Care coordination
- Support for resource utilization
- Works collaboratively with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources
- Makes significant contributions toward achievement of desired clinical, financial, and resource utilization outcomes
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
