Case Manager II, Registered Nurse

We are so glad you are interested in joining Sutter Health!

Organization

Bay Administration

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. When 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

* Graduate of an accredited school of nursing

Certification & Licensure

* RN-Registered Nurse of California Upon Hire
* CCM certification preferred

Typical Experience

* 5 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.

Job Shift

Day/Evening

Schedule

Full Time

Shift Hours

8

Days of the Week

Variable

Weekend Requirements

Every other Weekend

Benefits

Yes

Unions

No

Position Status

Non-Exempt

Weekly Hours

40

Employee Status

Regular

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

Pay Range is $90.58 to $126.81 / hour

The compensation range may vary based on the geographic location where the
position is filled. Total compensation considers multiple factors, including,
but not limited to a candidate’s experience, education, skills, licensure,
certifications, departmental equity, training, and organizational needs. Base
pay is only one component of Sutter Health’s comprehensive total rewards
program. Eligible positions also include a comprehensive benefits package.