RN, Health Plan Care Manager
About the role
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.
Responsibilities
- 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.
- Performs and/or coordinates preventative care, wellness, and nutritional counseling to Members.
- Develops and maintains positive relationships with customers internal and external.
- 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.
- 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.
Requirements
- Education and Work Experience: Bachelor's Degree in Nursing (BSN): Preferred Nursing experience: Preferred
- Licenses/Certifications: Certified Case Manager (CCM): Preferred Registered Nurse (RN) licensure in the state of practice: Required
Organizational Requirements
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.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify.
By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
About Us
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.
JOB INFO
- Job Identification : L53340-2
- Job Category : RN
- Posting Date : 2025-11-13T01:12:21+00:00
- Locations : Portland, OR, United States
- Assignment Category : Full-time regular
- Pay Range : The estimated base pay for this position is $45.39 to $62.26. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information.
- Hiring Department : EHP TPA/ARM
- Shift Length : 8 Hours