RN Case Manager, Acute Rehab

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

Organization:

ABSMC-Summit Campus

Position Overview:

Conducts preauthorization, concurrent, and retrospective utilization management review using the department’s accepted criteria for ambulatory, acute, and post-acute patients to confirm medical necessity is met and at the appropriate level of care. Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. Strives to promote patient wellness, improved care outcomes, and efficient utilization of health services among a patient population with complex health needs.

Job Description:

EDUCATION:

• Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:

• RN-Registered Nurse of California Required

• BLS-Basic Life Support Certification Required

• Certified Case Manager (CCM) Preferred

TYPICAL EXPERIENCE:

• Minimum of 2 years recent relevant experience Required

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:

Days

Schedule:

Part Time

Shift Hours:

8

Days of the Week:

Variable

Weekend Requirements:

Occasionally

Benefits:

Yes

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

24

Employee Status:

Regular

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

Pay Range is $86.68 to $114.41 / 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.