RN, Care Manager, Utilization Management (Part-time, Every weekend - Remote)

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

This position is Part time, day shift, Every Weekends and rotating holidays. Must live near Roseville, Glendale, or Portland.

Plays a critical role in ensuring that patients receive high-quality care while efficiently utilizing medical resources. Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments, and collaborating with healthcare providers and insurance companies to ensure a seamless care experience and the practicing of financial stewardship and denial prevention. Focuses on maximizing patient outcomes and optimizing resource allocation. Utilizes exceptional clinical knowledge, excellent communication skills, and the ability to thrive in a fast-paced and ever-changing healthcare environment.

Job Requirements

Education and Work Experience:

Associate’s Degree in nursing or equivalent combination of education/related experience: Required
Bachelor's Degree in Nursing (BSN): Preferred
Five years' acute hospital experience required with preferred experience in critical care areas: Required
Two years' utilization review experience using the Optum/Inter Qual product within the last 12 months: Required

Licenses/Certifications

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

Essential Functions

Completes clinical reviews of acute medical patients using the Optum/Inter Qual tool to determine if the patient is in the right acute setting, receiving the right acute services, during the appropriate length of stay.
Participates in annual Optum/Inter Qual training required. Takes the required annual Optum/Inter Qual Interrater Reliability (IRR) test with a minimum passing score as defined in the yearly departmental goals.
Meets weekly productivity metrics within 90 days of completing orientation and maintains on a weekly basis as defined in the yearly departmental goals. Meets quality audit metrics within 90 days of completing orientation and maintained on the audit cadence set within the department as defined in the yearly departmental goals.
Completes all required departmental education assigned with timeliness and accuracy. Follows all departmental workflows in communication variances to the on-site care management teams when appropriate. Reviews and analyzes medical records to assess the necessity and appropriateness of treatments and interventions.
Collaborates with healthcare professionals to develop and implement comprehensive patient care plans. Facilitates communication between the patient, healthcare team, insurance providers, and other stakeholders to ensure a coordinated and efficient care process. Stays up to date with the latest healthcare regulations, insurance guidelines, and evidence-based practices to ensure the delivery of optimal healthcare services.
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.

About Us

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.

Share this job

Related Jobs

Outpatient

Part-time

2 weeks ago

PRN RN

Crossover Health Elk Grove, CA

$52.07 - $68 / hour

About Crossover Health Crossover Health is creating the future of health as it should be. A national, team-based medical group with a focus on wellbeing and prevention that extends beyond traditional sick care, the company delivers an entirely new model of healthcare—Primary Health—built on the foundation of trusted relationships, an interdisciplinary care team approach, and outcomes-based payment. Crossover’s Primary Health model integrates primary care, physical medicine, mental health, health coaching, care navigation and more, and delivers care in surround-sound—in-person, virtually and via asynchronous messaging. Together we are building a community of members that embraces healthcare as a proactive part of their lifestyle. Job Summary The Registered Nurse (RN) is an essential part of the collaborative patient care team that supports an exceptional patient experience. Our RNs are empowered to practice and contribute throughout the care experience. At its core, the RN provides direct patient care while demonstrating servant leadership, leading clinic-wide huddles and leveraging our interdisciplinary approach to integrated care. The RN promotes a level of care that goes beyond industry standards and strives for excellence at every step. Job Responsibilities Performs evidence-based nursing care and patient education Performs care management by connecting patients with specialists and following up to ensure patients are getting the care they need Utilizes population management tools to ensure patients receive optimal care based on industry-wide recommendations Provides phlebotomy services, performs in-house laboratory tests and works with the provider to determine how and when to send out specialty labs Screens for vaccine-preventable diseases and administers primary care and travel-related immunizations Manages RN schedule and appropriateness of appointments. Takes initiative to contact patients when needed and demonstrate knowledge of when to consult with a provider Complies with all policies, procedures, and protocols of the practice, including performing specific care under standing orders Provides general triage services to walk-ins and over the phone. Assesses patient’s needs, consult provider when needed and direct appropriate care Provides occasional on-site care at client-sponsored events such as flu clinics and biometric screenings Participates in quality improvement programs to ensure the practice is performing efficiently and in accordance with Crossover’s policies Demonstrates proficiency in the use of healthcare analytic tools, systems, and analysis Participates in implementation of new health technologies, products, services, and programs that establish the Crossover Medical Group as a recognized thought leader for employer-based health care and lifestyle medicine programs Manages population health programs and clinic outreach initiatives Serves as a resource to other nurses and the care team, and participate in the training and onboarding of new nurses Assists in performing Quality and Compliance checks required on a daily, weekly and monthly basis Contributes to reporting requirements related to incident reporting and compliance Performs other duties as assigned. Required Qualifications Graduate from an accredited school of nursing Minimum 3 years of clinical experience Current Registered Nurse license in the state you are practicing Current BLS (Basic Life Support) certification Preferred Qualifications Bachelor of Science Degree in Nursing (BSN) Outpatient care and urgent care experience Knowledge of Apple and Google-based technology or client technologies such as Microsoft or HP Passion for delivering a best-in-class patient care experience in an integrated patient-centered primary care model Creative, flexible and easily adapts to changing priorities Energetic, takes initiative and able to work in a team environment as well as autonomously when needed Embraces new ways of delivering healthcare Physical Job Requirements Requires standing, walking and sitting for extended periods of time Includes full range of body motion including potential of handling and lifting patients Requires corrected vision, hearing and speech within normal ranges Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions The base pay range for this position is $52.07 to $68 per hour. Pay range may vary depending on work location, applicable knowledge, skills, and experience. This position will be eligible for 401K. Crossover Health is committed to Equal Employment Opportunity regardless of race, color, national origin, gender, sexual orientation, age, religion, veteran status, disability, history of disability or perceived disability. If you need assistance or an accommodation due to a disability, you may email us at careers@crossoverhealth.com . To all recruitment agencies : We do not accept unsolicited agency resumes and are not responsible for any fees related to unsolicited resumes. #LI-Onsite

Aesthetic

Full-time

1 day ago

Registered Nurse – Aesthetic Training Provided

LaserAway Elk Grove, CA

$50/hr base + $5/hr weekend differential No overnights You'll be the clinical expert patients trust to achieve results they didn't think were possible without surgery — owning every treatment relationship from first consult through long-term results. About LaserAway LaserAway is the nation's leader in aesthetic dermatology. We specialize in advanced, non-surgical treatments that combine medical expertise and cutting-edge technology. Our clinics run at high volume with a team-first culture — clinicians here help build loyal patient books and have a real voice in how care is delivered. What You'll Own Your patient's full clinical journey — from initial skin assessment and treatment planning through follow-up care and long-term results. You'll partner with Patient Care Coordinators and Location Directors to deliver seamless, individualized care on a busy clinic floor. Day-to-day: performing laser, injectable, and skin rejuvenation treatments; documenting accurately; and staying engaged in a high-volume environment. You'll work with a custom EMR built for LaserAway — fully digital and designed to simplify charting so you stay focused on patients, not paperwork. And as we continuously add the latest FDA-cleared technologies to our treatment menu, you'll always be practicing at the forefront of aesthetic medicine. Who Thrives Here Current, active unencumbured RN license (state-issued) Background in acute care (ER, ICU, Med-Surg) or aesthetics practice preferred, but not required Professional, dependable, and genuinely patient-centered Weekend availability Comfortable in a high-volume clinic environment treating 15–25 patients per day Ability to work at up to 3 assigned locations Compensation & Benefits Competitive base pay 50.00 + $5/hr weekend differential Full-time hours available (32–40 hrs/week, 8-hour shifts) Scheduling flexibility to balance clinical volume with your lifestyle Medical, dental, and vision insurance 401(k) with company match Paid time off Free Figs scrubs Employee discounts on treatments and products Growth Path Comprehensive hands-on training across all aesthetic modalities from day one Clear advancement into Lead Nurse and Regional Clinical Trainer roles Clinicians who excel here become the clinical voice that shapes how we train the next wave of practitioners LaserAway is an Equal Opportunity Employer. We're committed to creating an inclusive workplace and will provide reasonable accommodations as required by law. Benefits Summary LaserAway provides competitive compensation packages and a comprehensive range of benefits, including Medical, Dental, Vision, Disability and Life Insurance, a 401(k) plan with a company match, and additional ancillary benefits. We also offer Paid Time Off (PTO) in compliance with state and federal requirements, ensuring our employees are supported both professionally and personally. LaserAway also provides incentive compensation, including potential bonuses and commissions, depending on role and performance.

Assistant Clinical Nurse Manager

WelbeHealth Elk Grove, CA

$129,521.60 - $161,865.60 / year

WelbeHealth PACE helps seniors stay in their homes and communities by providing comprehensive medical care and community-based services. We serve the most vulnerable seniors with better quality and compassion in a model value-based model. Reporting to the Clinical Nurse Manager, the Assistant Clinical Nurse Manager is accountable for both people management and RN-level nursing care. Under the direction of the Executive Director, the WelbeHealth Assistant Clinical Nurse Manager directs the day-to-day work at the clinic, oversees the clinic staff, and coordinates clinical flow to ensure that services are provided effectively and quality of care standards are met. This role is different because Assistant Clinical Nurse Managers at WelbeHealth: Have the opportunity to grow their career at a faster rate than in other settings Integrate patient-centered care with operational leadership to ensure efficient day-to-day clinic operations We care about our team members. That’s why we offer: Medical insurance coverage (Medical, Dental, Vision) Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days 401K savings + match Comprehensive compensation package including base pay and bonus And additional benefits! On the day-to-day, you will: Provide leadership, oversight, and performance management to RN, LVN, and MA staff, ensuring they all have role clarity and the required training to perform their functions at the top of their license Oversee clinic function to ensure both chronic and acute participant needs are addressed properly Liaise with the Complex Care team on smooth transitions of care to meet post-discharge needs Develop workforce plans and ensure appropriate staffing, recognizing the diverse experience levels of staff members and the unique needs of participants Participate actively in direct participant care to ensure needs are met, practicing within the RN level of care Manage direct reports including hiring, training, supervising, and mentoring, as well as exercise flexibility in performing assignments as business needs evolve Job requirements include: Graduate of an accredited school of nursing with unencumbered RN license required; bachelor’s degree (BSN) preferred Minimum of two (2) years of nursing experience in a clinical setting with a frail or elderly population Minimum of one (1) year of supervisory experience with demonstrated ability to mentor and develop team members preferred Minimum of one (1) year of case management, care coordination, or related specialty preferred Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and project Must be willing to work a varied schedule that may include nights, weekends, and overtime We are seeking Assistant Clinical Nurse Managers that ideally have outpatient/clinical experience. If you’re ready to join a holistic care team that values both its participants and providers, we’d love to hear from you! Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications. Compensation Offering $129,521.60 — $161,865.60 USD COVID-19 Vaccination Policy At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations. Our Commitment to Diversity, Equity and Inclusion At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law. Beware of Scams Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to fraud.report@welbehealth.com

Wound Care RN

WelbeHealth Elk Grove, CA

$47.74 - $61.12 / hour

The WelbeHealth PACE program helps seniors stay in their homes and communities by providing comprehensive medical care and community-based services. We’re driven to offer the best care for our participants and provide a positive work environment for our team. The Home Health RN provides skilled, compassionate care in participants’ homes under CMS guidelines, ensuring participants convenient access to essential health services where they feel most comfortable. Working closely with the interdisciplinary team (IDT), this role coordinates care plans to empower participants to live healthier, more independent lives. This role is different because Home Health RNs at WelbeHealth: Skip OASIS assessments and get to focus on patient care Earn hourly pay that includes travel time rather than getting paid per visit Have work-life balance through flexible scheduling and built-in documentation time We care about our team members. That ’ s why we offer: Medical insurance coverage (Medical, Dental, Vision) Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days 401K savings + match Comprehensive compensation package including base pay and bonus And additional benefits! On the day-to-day, you will: Conduct home health nursing assessments to determine the nursing equipment needs in the home, including participant preferences and goals Actively participate in IDT meetings to develop participant care plans Deliver and document home health nursing interventions as agreed upon in participant care plans, including but not limited to maintaining a healthy and safe environment, promptly responding to physician orders, and accurately administering medications and performing ordered tests and treatments Instruct participants, their families, and caregivers regarding the disease process, self-care techniques, and prevention strategies related to their medical conditions Track and monitor home health scheduling in collaboration with the Home Health Manager or scheduling point of contact Collaborate with the Physician and other IDT members to assist in smooth care transitions between settings (hospitals, skilled nursing facilities, home, etc.) Job requirements include: Graduate of an accredited school of nursing Unencumbered RN License required Minimum of one (1) year of nursing experience in a clinical setting with a frail or elderly population; home health agency experience preferred Reliable means of transportation Must obtain CPR and First Aid certification within 180 days of hire and maintain certification thereafter; CPR and First Aid certification upon hire preferred We are seeking Home Health RNs that ideally have experience working with frail and elderly populations. If you’re ready to join a holistic care team that values both its participants and providers, we’d love to hear from you! Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications. Compensation Offering $47.74 — $61.12 USD COVID-19 Vaccination Policy At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations. Our Commitment to Diversity, Equity and Inclusion At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law. Beware of Scams Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to fraud.report@welbehealth.com

Hospice

Full-time

2 months ago

Hospice RN Case Manager

Anchor Health Elk Grove, CA

HOSPICE RN CASE MANAGER *** 5k sign on bonus Job details Job Type Full-time Qualifications RN License (Required) Hospice care: 1-2 years (Preferred) Full Job Description Hospice RN Case Manager ANCHOR HEALTH, a new premier hospice organization which provides expertise, compassion, and care for our patients and their families as they face terminal illness. Our team of professionals helps improve quality of life by addressing the physical, emotional, and spiritual needs of our patients. Through this interdisciplinary approach, we seek to comfort the heart, mind, and body. The Hospice Registered Nurse is an experienced registered professional nurse who initiates and coordinates the hospice care plan plans, organizes, and directs hospice care and is experienced in nursing, with emphasis on community health education/experience. The professional nurse builds from the resources of the community to plan and direct services to meet the needs of individual and families within their homes and communities. Essential Job Responsibilities: The RN provides care to patients who have been diagnosed with a terminal illness. The Hospice RN regularly reviews and updates the plan of care. Performs prescribed medical treatments, including pain management and symptom control, conducts assessments and evaluations, provides education and supportive care to patient and family. Completes an initial, comprehensive, and ongoing assessments of patient and family to determine hospice needs. Provides a complete physical assessment and history of current and previous illness(es). Provides professional nursing care by utilizing all elements of nursing process. Assesses and evaluates patient’s status by: Writing and initiating plan of care, regularly re-evaluating patient and family/caregiver needs, participating in revising the plan of care as necessary. Uses health assessment data to determine nursing diagnosis. Develops a care plan that establishes goals, based on nursing diagnosis, and incorporates palliative nursing actions. Includes the patient and the family in the planning process. Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician in the physician’s plan of care. Counsels the patient and family in meeting nursing and related needs. Provides health care instructions to the patient as appropriate per assessment and plan. Assists the patient with the activities of daily living and facilitates the patient’s efforts toward self-sufficiency and optional comfort care. Acts as Case Manager when assigned by Clinical Supervisor/Nursing Supervisor and assumes responsibility to coordinate patient care for assigned caseload. Completes, maintains, and submits accurate and relevant clinical notes regarding patient’s condition and care given. Records pain/symptom management changes/outcomes as appropriate. Communicates with the physician regarding the patient’s needs and reports changes in the patient’s condition; obtains/receives physicians’ orders as required. Communicates with community health related persons to coordinate the care plan. Teaches the patient and family/caregiver self-care techniques as appropriate. Provides medication, diet and other instructions as ordered by the physician and recognizes and utilizes opportunities for health counseling with patients and families/caregivers. Works in concert with the interdisciplinary group. Provides and maintains a safe environment for the patient. Assists the patient and family/caregiver and other team members in providing continuity of care. Works in cooperation with the family/caregiver and hospice Interdisciplinary Group Members to meet the emotional needs of the patient and family/caregiver. Attends interdisciplinary group meetings. Position Qualifications Registered Nurse with valid CA state license. Hospice experience preferred. At least one year of recent hospice experience along with a strong foundation of acute care experience. Maintains a current CPR certification. Valid driver’s license, auto insurance, reliable transportation, and willingness to drive to patient locations. Ideal candidates must have excellent interpersonal skills, motivated and a passion for Hospice. Benefits: Mileage reimbursement Medical specialties: Hospice & Palliative Medicine Schedule: Monday to Friday Experience: Hospice care: 1 year (Preferred) License/Certification: RN License (Required) Work Location: On the road Pay Range - based on experience. Up to $60/hr