RN, Care Manager, Utilization Management (Remote)

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Clinical Support
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Corporate
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67185 Requisition #

Adventist Health is more than an award-winning health system. We provide whole-person care to our communities and champion the greater good - from the operating room to the boardroom, we are driven by our unique passion to live God's love through health, wholeness and hope. From Oregon to Oahu, we have a calling to always do more. Now is your chance to apply your passion to our mission.

We're looking for someone to join our team as a Care Manager, Utilization Management who:

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.

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.

You'll be successful with the following qualifications:

Education:

  • Associate's Degree in nursing or equivalent combination of education/related experience: Required
  • Bachelor's Degree in nursing: Preferred

Work Experience:

  • 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

Required Licenses/Certifications:

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

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.

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