Job Description
These coordinators ensure members receive appropriate health services by managing utilization and care plans, benefiting patients with complex needs. They review medical necessity using established criteria, coordinate discharge plans, and communicate with providers to facilitate smooth transitions from hospitals to home care.
Adventist Health operates over 440 sites across California and Oregon, providing care to more than 100 communities as a nonprofit system founded on faith-based values. The organization focuses on whole-person care with specialized services in hospitals, clinics, and home care for over 38,000 employees sourcing from diverse backgrounds.
In this function, coordinators serve as liaisons between members, providers, and internal teams, leading retrospective reviews and confirming orders using electronic systems. They enhance discharge planning with physicians and staff, perform ongoing collaborations to meet necessity criteria, and work on quality initiatives involving resource allocation and cost reductions. A key challenge involves handling frequent changes in patient conditions that affect care plans.
The role offers salary based on experience, located in Roseville, California, with flexible full-time or part-time arrangements depending on needs. Benefits include comprehensive health coverage, a 401(k) match, paid parental leave, eight holidays, and professional development through leadership programs and resource access on the WELL-certified campus.
Responsibilities
- Coordinate utilization, disease, and case management for health plan members
- Function as liaison to members, providers, and internal departments
- Lead retrospective review process and confirm orders
- Communicate changes that could affect discharge plans
Requirements
- Registered Nurse (RN) license in state of practice
- High School Education/GED or equivalent
- Five years' related experience preferred
- Associate’s/Technical Degree or equivalent preferred