Health Plan Care Management Coordinator (OR) chez Adventist Health Glendale

Education and Work Experience:

• High School Education/GED or equivalent: Preferred
• Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred
• Five years' related experience: Preferred

Facility Specific License/Certifications:

• Registered Nurse (RN) license in state of practice: Required

Essential Functions:

• Functions as liaison to members, providers, case coordinators, discharge planners, contracted health plans/partners and internal departments. Leads retrospective review process. Confirms orders utilizing established criteria.
• Enhances communication related to discharge planning and utilization management. Maintains effective communication with health care team members related to care coordination and utilization management. Performs ongoing collaboration with staff to ensure condition meets medical necessity criteria.
• 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.
• Ensures ongoing collaboration with staff to ensure condition meets medical necessity criteria. Communicates changes that could affect the discharge plan of care.
• 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 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.

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.