RN, Supervisor, Health Plan Care Management
About The Position
Adventist Health Roseville is seeking an RN Supervisor, Health Plan Care Management for a full-time position with 8-hour day shifts. This role involves supervising the development, implementation, and evaluation of services provided by the care management department. The goal is to enhance member management by promoting continuity of care and cost-effectiveness through whole-person inpatient and outpatient management, care integration, case management, utilization review, and care planning. The position also involves supervising and directing the activities of assigned personnel using professional and supervisory discretion and independent judgment.
Requirements
- Bachelor’s Degree in nursing or equivalent combination of education/related experience: Required
- Registered Nurse (RN) licensure in the state of practice: Required
Nice To Haves
- Master's Degree: Preferred
- Five years' technical experience: Preferred
- Certified Case Manager (CCM): Preferred
Responsibilities
- Supervises the development, implementation and evaluation of the services provided by the 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.
- 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.
- Exercises independent judgment in recruiting, training, coaching, supervising and responsibly directing assigned staff.
- 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.
- Performs other job-related duties as assigned.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Manager
