Health Underwriting Manager jobs in Modesto, CA

Education and Work Experience:

• Bachelor's Degree in Nursing (BSN): Preferred
• Experience in a care management role: Preferred

Licenses/Certifications:

• Registered Nurse (RN) licensure in the state of practice: Required
• Case management certification: Preferred
• Basic Life Support (BLS OR HS-BLS OR RQI BLS) certification: Required

Essential Functions:

• Leads the coordination of patient care with other disciplines within the care team, monitoring the appropriateness and timeliness of care.
• Ensures the interdisciplinary care plan is consistent with the patient's clinical course, continuing care needs and covered services by monitoring diagnostic testing, treatments and procedures, and other aspects of patient care as appropriate for acute care.
• Discusses with physicians, the appropriateness of resource utilization, consultations, treatment plan, estimated length of stay and discharge plan. Focuses on complex patients, frequent emergency department utilizers, chronic pain and substance abuse patients, and homeless patients. Collaborates with acute care case managers to ensure appropriateness on ongoing care.
• Coordinates the transfer of patients to tertiary centers, including the transfer of patient information required for continuity of ongoing treatment and services.
• Provides oversight and collects data required for regulatory/accreditation compliance. Manages frequent emergency department visitors by conducting a focus study review of the previous and current admissions.
• 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, 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.