Case Manager, Registered Nurse

Position Overview :

Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions.

The Care Management process encompasses communication and facilitates care across the continuum through effective resource coordination.

The goals of this role are to include the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self determination while coordinating in a timely and integrated fashion.

He / She collaborates with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources.

If assigned to the Emergency Department, the Care Management process is to address complex clinical and social situations efficiently in order to avoid unnecessary admissions.

Job Description : EDUCATION :

EDUCATION :

Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE :

RN-Registered Nurse of California Upon Hire

TYPICAL EXPERIENCE :

2 years recent relevant experience.

SKILLS AND KNOWLEDGE :

A broad knowledge base of health care delivery and case management within a managed care environment.

Comprehensive knowledge of Utilization Review, levels of care, and observation status.

Awareness of healthcare reimbursement systems : HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems preferred.

Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system : including but not limited to : CMS, Title 22, CHA Consent Manual, CDPH and TJC.

A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements.

General understanding of coding and DRG assignment process preferred.

Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients / families / caretakers, physicians, nurses and other ancillary partners.

Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.

Demonstrates commitment to service excellence in all patients, family and employee interactions and in performing all job responsibilities.

Functions in a manner to promote quality patient care and assure a positive patient experience.

Strong verbal and written communication skills and negotiation skills

Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.

Intermediate computer and technology skills.

Ability to promote teamwork and to effectively function in teams.

Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience.

PHYSICAL ACTIVITIES AND REQUIREMENTS :

See required physical demands, mental components, visual activities & working conditions at the following link :

Job Shift : Days

Days

Schedule : Full Time

Full Time

Shift Hours : Days of the Week :

Days of the Week :

Friday, Monday, Thursday, Tuesday, Wednesday

Weekend Requirements :

None

Benefits : Unions :

Unions : Position Status :

Position Status : Non-Exempt

Non-Exempt

Weekly Hours : Employee Status :

Employee Status : Regular

Regular

Number of Openings :

Sutter Health is an equal opportunity employer EOE / M / F / Disability / Veterans.

Pay Range is $79.37 to $104.76 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled.

Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs.

Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Qualified applicants with arrest and conviction records will be considered for employment. Applicants for specific positions are still required to disclose certain convictions during the application process, and those convictions may also be considered in determining eligibility for employment in accordance with applicable law.