RN, Health Plan Care Manager-Roseville-CA-20083-Pay Negotiable

RN, HEALTH PLAN CARE MANAGER

Job Summary:
Manages the development, implementation, and evaluation of care management services. Promotes continuity of care, cost effectiveness, care integration, case management, utilization review, and care planning.

Education & Experience:
• Bachelor's Degree in Nursing (BSN) (Preferred)
• Nursing experience (Preferred)

Licenses & Certifications:
• Registered Nurse (RN) licensure in state of practice (Required)
• Certified Case Manager (CCM) (Preferred)

Key Responsibilities:
• Coordinates care management services for Health Plan members.
• Partners with physicians, claims, and data management teams to support member care.
• Coordinates preventative care, wellness, and nutritional counseling.
• Collaborates on quality improvement, resource utilization, and cost reduction initiatives.
• Reviews member conditions for medical necessity criteria.
• Manages discharge planning and utilization management communication.
• Maintains positive relationships with internal and external customers.
• Performs other job-related duties as assigned.