RN Care Coordinator II Job at Rady Children's Hospital-San Diego (San Diego)

Care Management Specialist II, D-SNP Team

The Care Management Specialist II utilizes clinical skills and training to perfo...

Location

United States , Los Angeles

Salary:

88854.00 - 142166.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses OR Master's Degree in Social Work for Licensed Clinical Social Workers
Minimum of 3 years of recent care management experience with responsibilities of managing complex acute or chronic conditions in collaboration with members and interdisciplinary care professionals in a hospital, medical group or managed care setting, such as a health insurance environment and/or experience as care manager in home health or hospice environments
Experience providing care management with complex/catastrophic conditions
Current knowledge of clinical standards of care and disease processes
Critical thinking skill
Excellent customer service skills
Ability to clinically analyze the most complex cases involving highly acute physical health, behavioral health, complex/catastrophic and/or psychosocial issues to determine and implement the most effective member-centered interventions
Ability to triage immediate member health and safety risks
Ability to sensitively manage member or family responses associated with high acuity cases and support effective coping
Strong verbal and written communications skills to consult effectively with interdisciplinary teams, coordinate care with members and their families, and other internal and external stakeholders

Job Responsibility

Utilizes clinical skills and training to perform essential functions of care management for identified and assigned member population according to Health Insurance Portability and Accountability Act (HIPAA) guidelines
Manages a specified caseload across the entire continuum of programmatic levels including those within National Committee for Quality Assurance (NCQA) scope or otherwise Complex/Catastrophic cases
Management of the caseload assigned by Manager includes: coordinating health care benefits, providing education and facilitating member access to care in a timely and cost-effective manner
Collaborates and communicates with member, family, and interdisciplinary health team to promote wellness and member empowerment, while ensuring access to appropriate services across the healthcare continuum and maximizing member benefit
Serves as clinical advocate for members, active interdisciplinary team member, liaison with other departments and external health care team
Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings, reminder calls, satisfaction surveys, incentives or any additional service needs according to specific program guidelines
Uses claims processing and care management software to look up member information, document contacts, and track member progress
Applies clinical knowledge and experience to evaluate information regarding prospective care management members referred by health risk assessment (HRA), risk stratification, predictive modeling, provider’s utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs
Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric communication which includes the interdisciplinary team, providers and family or authorized representatives
reviewing member claims histories and identifies intervention opportunities through the professional standards of practice

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

RN Care Coordinator II - Infectious Disease

The Infectious Disease division cares for patients with general and complex diag...

Location

United States , San Diego

Salary:

Not provided

Rady Children's Hospital-San Diego

Expiration Date

Until further notice

Requirements

Associate's Degree
Two years of nursing experience
California RN License
BLS for Healthcare Providers, issued by AHA

Job Responsibility

Performs case management and direct patient care to assigned patients
Includes point of care procedures, management of central lines, procedures in clinic, ongoing patient, family and staff education and coordination of care with outside community agencies
Triages and manages patient requests and needs via telephone triage and patient messaging via EPIC
Partners and supports continued growth of medical assistants to deliver well rounded care
Facilitates effective functionality of clinic operations, actively participates in Quality Management and acts as a provider extender within his/her scope of practice
Performs additional team functions as required to maintain effective customer service

What we offer

Medical, Dental, Vision
403(b) Retirement Plan with 100% employer match up to 3% of salary
Tuition Reimbursement up to $2,000 per year, paid time off for seminars
Life and Disability Insurance
Infertility Reimbursement
Annual merit increases, longevity increases, success sharing, paid leave cash-out program
Annual Team Rady event, milestone awards, CARES recognition

Fulltime

RN Care Coordinator II - Pulmonology

The Care Coordinator, in collaboration with Pulmonology specialty medical provid...

Location

United States , San Diego

Salary:

58.87 - 101.32 USD / Hour

Rady Children's Hospital-San Diego

Expiration Date

August 15, 2026

Requirements

Associate's Degree
Area of Study in a Field Related to the Position (PULM)
Two years of experience
California RN License
BLS for Healthcare Providers, issued by AHA

Job Responsibility

Performs case management and direct patient care to assigned patients
Performs point of care procedures
Manages Pulmonology and other medical devices
Provides ongoing patient, family and staff education
Coordinates care with outside community agencies
Triages and manages patient requests and needs via telephone triage and patient messaging via EPIC
Partners and supports continued growth of medical assistants
Facilitates effective functionality of clinic operations
Actively participates in Quality Management
Acts as a provider extender within his/her scope of practice

What we offer

Medical, Dental, Vision
403(b) Retirement Plan with 100% employer match up to 3% of salary
Tuition Reimbursement up to $2,000 per year
Life and Disability Insurance
Infertility Reimbursement
Annual merit increases
Longevity increases
Success sharing
Paid leave cash-out program
Annual Team Rady event

Fulltime

RN Care Coordinator II - Cardiovascular Surgery

The Care Coordinator, in collaboration with specialty medical providers, perform...

Location

United States , San Diego

Salary:

Not provided

Rady Children's Hospital-San Diego

Expiration Date

Until further notice

Requirements

Associate's Degree in a Field Related to the Position
Two years of experience
California RN License
BLS for Healthcare Providers, issued by American Heart Association

Job Responsibility

Performs case management and direct patient care to assigned patients
Performs point of care procedures
Provides ongoing patient, family and staff education
Coordinates with outside community agencies
Facilitates effective functionality of clinic operations
Actively participates in Quality Management
Acts as a provider extender within their scope of practice
Performs additional team functions as required to maintain effective customer service

What we offer

Medical, Dental, Vision
403(b) Retirement Plan with 100% employer match up to 3% of salary
Tuition Reimbursement up to $2,000 per year
Paid time off for seminars
Life and Disability Insurance
Infertility Reimbursement
Annual merit increases
Longevity increases
Success sharing
Paid leave cash-out program

Clinical Surgery Coordinator RN II

The RN – Clinical Surgery Coordinator assists in the development of the orthoped...

Location

United States , Chattanooga

Salary:

35.27 - 50.62 USD / Hour

CommonSpirit Health

Expiration Date

Until further notice

Requirements

Registered Nurse: TN (RN:TN)
Basic Life Support - CPR (BLS-CPR) upon hire
Advanced Cardiac Life Support (ACLS) upon hire
Surgery experience required

Job Responsibility

Assists in the development of the orthopedic surgical service by planning and evaluating instrument, supply and equipment needs for orthopedic procedures
Functions as a Surgical First Assistant to provide quality patient care in the operating room
Utilizes knowledge from biological, physical, and social sciences to assist the Manager in ensuring the effective delivery of nursing care
Applies specialized knowledge to support the coordination of surgical services, optimize patient flow, and ensure adherence to best practices in the surgical environment
Contributes to maintaining high standards of patient safety and care quality

What we offer

Health/dental/vision
FSA
Matching retirement plans
Paid time off
Tuition assistance
Adoption assistance

Fulltime

Medical Appeals/Grievance Specialist II - Registered Nurse

Responsible for utilizing clinical acumen and managed care expertise related to ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

1 year experience in clinical and health insurance or other healthcare related field
3 years experience in clinical and health insurance or other healthcare related field AND 1 year Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
5 years experience in clinical and health insurance or other healthcare related field AND 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
8 years experience in clinical and health insurance or other healthcare related field AND 3 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
Associate’s Degree in a healthcare field of study or Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN), a Physical Therapist (PT) or a Licensed Master Social Worker LMSW.
Intermediate PC proficiency
Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
Maintain complete and accurate records per department policy.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Attend staff and interdepartmental meetings.
Participate in continuing education and current developments in the fields of medicine and managed care.

Fulltime

R.N. II DOU

As a nurse at Emanate Health, you are a source of healing. You put patients firs...

Location

United States , Covina

Salary:

48.97 - 74.88 USD / Hour

Emanate Health

Expiration Date

Until further notice

Requirements

Minimum Experience Requirement: All (1) newly graduated nurses, (2) re-entry nurses, and (3) nurses new to the U.S. healthcare system must satisfactorily complete the Emanate Health R.N. New Grad Program
One year critical care experience is preferred
Excellent customer service skills required
Minimum License Requirement: Current RN license in the State of California
BLS certification required
ACLS certification within 3 months
National Institutes of Health (NIH) Stroke Scale Certification "A" required within 3 months of hire/transfer for those working at QVH in ICU, CCU, or NEURO Departments and FPH in ICU/CCU or DOU
Annual 8 hours of Stroke Education required for those working at QVH in ICU, CCU, or Neuro Departments
Must be available to work every other weekend

Job Responsibility

The Staff RN is a professional caregiver who assumes responsibility and accountability for a group of patients for a designated time frame
He/she is a clinical practitioner who coordinates and implements patient care specific to the age of the patient population served on the assigned units
He/she ensures that quality care is provided in an efficient and safe manner consistent with the unit's standard of care
Utilizes nursing skills to determine the biophysical, psychosocial, environmental, self-care and educational needs of the patient/family/significant other to develop, implement and revise the plan of care

What we offer

Medical
Dental
Vision
401(k)/Retirement Plans
Tuition Reimbursement
Work-Life Balance

Fulltime

R.N. II DOU

As a nurse at Emanate Health, you are a source of healing. You put patients firs...

Location

United States , Covina

Salary:

48.97 - 74.88 USD / Hour

Emanate Health

Expiration Date

Until further notice

Requirements

Current RN license in the State of California
BLS certification required
ACLS certification within 3 months
National Institutes of Health (NIH) Stroke Scale Certification "A" required within 3 months of hire/transfer for those working at QVH in ICU, CCU, or NEURO Departments and FPH in ICU/CCU or DOU
Annual 8 hours of Stroke Education required for those working at QVH in ICU, CCU, or Neuro Departments
Must be available to work every other weekend
All newly graduated nurses, re-entry nurses, and nurses new to the U.S. healthcare system must satisfactorily complete the Emanate Health R.N. New Grad Program

Job Responsibility

Assumes responsibility and accountability for a group of patients for a designated time frame
Coordinates and implements patient care specific to the age of the patient population served on the assigned units
Ensures that quality care is provided in an efficient and safe manner consistent with the unit's standard of care
Utilizes nursing skills to determine the biophysical, psychosocial, environmental, self-care and educational needs of the patient/family/significant other to develop, implement and revise the plan of care

What we offer

Medical
Dental
Vision
401(k)/Retirement Plans
Tuition Reimbursement
Work-Life Balance

Fulltime

RN Care Coordinator II

Rady Children's Hospital-San Diego

Location:
United States , San Diego

Category:
Nursing

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
January 16, 2026

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R.N. II DOU

RN Care Coordinator II

Rady Children's Hospital-San Diego

Location:United States , San Diego

Category:Nursing

Contract Type:Not provided

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Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:January 16, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

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Location:
United States , San Diego

Category:
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Job Posted:
January 16, 2026