Care Manager, Registered Nurse

Job description

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

nOrganization:

nSMCS-Valley Administration

nPosition Overview:

nResponsible 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.

nJob Description :

nEDUCATION:

nGraduate of an accredited school of nursing

nCERTIFICATION & LICENSURE:

nRN-Registered Nurse of California Upon Hire

nTYPICAL EXPERIENCE:

n2 years recent relevant experience

nOR graduate of an accredited Master's degree program in Nursing with a specialization in Case Management

nSKILLS AND KNOWLEDGE:

nExperience in acute care case management or health plan case management/utilization management.

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

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

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

nWorking 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.

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

nGeneral understanding of coding and DRG assignment process preferred.

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

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

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

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

nStrong verbal and written communication skills and negotiation skills

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

nIntermediate computer and technology skills.

nAbility to promote teamwork and to effectively function in teams.

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

nJob Shift:

nDays

nSchedule:

nFull Time

nShift Hours:

n8

nDays of the Week:

nVariable

nWeekend Requirements:

nOne Weekend Shift a month

nBenefits:

nYes

nUnions:

nNo

nPosition Status:

nNon-Exempt

nWeekly Hours:

n40

nEmployee Status:

nRegular

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

nPay Range is $82.48 to $115.46 / hour

nThe 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.

Worksite address

roseville, CA, 95678, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.