Remote RN, Care Manager, Utilization Management – California
Job Overview
- Clinical License RN
- State(s) CA
Job Description
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.
Whether virtual or on campus, 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:
Reviews the utilization of resources and works to reduce unnecessary lengths of stay and the over utilization of hospital services. Reviews the medical record for quality and utilization indicators, recording and communicating identified variances as appropriate through data collecting forms and quality indicator monitoring processes. Communicates with the health care team, payers and others to promote quality cost-effective outcomes by utilizing available resources and decrease fragmentation of care across all settings. Responsible for promotion/role modeling, mentors staff, collaborates with on-site care management team. This is a remote – work from home position.
Job Requirements:
Education and Work Experience:
- Associate’s Degree in nursing or equivalent combination of education/related experience: Required
- Bachelor’s Degree in nursing: Preferred
- Five years’ acute hospital RN experience: Required
- Two years’ CM/UM experience – may be waived with equal experience as an RN in an ED setting whose role includes discharge planning: Required
- One year leadership experience: Preferred
Licenses/Certifications:
- Registered Nurse (RN) licensure in the state of practice: Required
Essential Functions:
- Completes a review of an acute medical patient to determine if the patient is in the right setting, receiving the right services and for the right length of stay, using a RN algorithm tool. The tool requires training and a strong broad baseline in nursing knowledge to accurately be applied. Yearly education and testing is required to remain compliant.
- Notifies in-hospital care managers or physician advisors of any variances in services, stay or level for changes to be made.
- Maintains education and learning on current processes/practices.
- Performs other job-related duties as assigned.
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, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.
About Us
Adventist Health is a faith-based, nonprofit, integrated health system serving more than 90 communities on the West Coast and Hawaii with over 400 sites of care, including 26 acute care facilities, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of 37,000 includes employees, physicians and volunteers driven in pursuit of one mission: living God’s love by inspiring health, wholeness and hope.
