RN Care Team Manager

About the role

The RNCTM position at AHF focuses on removing access to care/community resource barriers and improving health outcomes, as well as health equity.

Responsibilities

• Remove access to care/community resource barriers and improve health outcomes
• Ensure timely case processing of grievances, including access to care & quality of care (QOC) cases, QOC Potential Quality Issue (PQI) investigations, and critical incident identification, tracking, and monitoring
• Decrease the Division of Medicine (DOM) prior authorization denial rate
• Utilize core principles of Risk Management to cultivate and facilitate essential functions for AHF patients
• Work collaboratively with all AHF staff to ensure timely triaging and processing of grievances, PQIs, & related investigations
• Mitigate prior authorization denials & appeals submitted by the AHF Healthcare Centers by trending common denial reasons, educating providers on documentation best practices, and promoting awareness of payer-specific requirements and updates to nursing/referral teams

Requirements

Licenses and Certifications:

• CA Registered Nurse (RN) License required
• Multistate RN License within 6 months of hire required
• Managed Care experience preferred
• Grievance/Appeals/Quality Improvement experience preferred
• Bilingual Spanish preferred