Care Manager II, Acute

Sutter Health•Modesto, CA

1d•$82 - $115

About The Position

Responsible for care coordination and care transitions planning throughout the acute-care patient experience. The role works collaboratively with the Physician, Utilization Manager, Medical Social Worker, and bedside RN to support timely progression and transition to the appropriate level of care and prevent unnecessary admissions or readmissions. Care management facilitates communication and care across the continuum through effective resource coordination, with the goals of optimal health, access to care, appropriate resource utilization, and respect for patients’ self-determination. The position 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, contracted providers, and community resources. If assigned to the Emergency Department, the role addresses complex clinical and social situations efficiently to avoid unnecessary admissions.

Requirements

Graduate of an accredited school of nursing.
California Registered Nurse (RN) license upon hire.
Two years of experience in acute-care case management or health-plan case management/utilization management.
Broad knowledge of health-care delivery and case management within a managed-care environment.
Comprehensive knowledge of utilization review, levels of care, and observation status.
Working knowledge of laws, regulations, and professional standards affecting case management in an integrated delivery system, including CMS, Title 22, CHA Consent Manual, CDPH, and TJC.
Broad knowledge of post-acute levels of care and associated regulatory compliance requirements.
Ability to communicate effectively and promote cooperation and collaboration among patients, families, caretakers, physicians, nurses, and ancillary partners.
Ability to work independently and exercise sound judgment in interactions with physicians, payers, patients, and families.
Commitment to service excellence in interactions and job responsibilities.
Strong verbal, written communication, and negotiation skills.
Excellent time-management skills and ability to organize work in a high-volume environment with rapidly changing priorities.
Intermediate computer and technology skills.
Ability to promote teamwork and function effectively in teams.
Ability to collaborate effectively with internal and external constituents using customer-service skills that promote excellence in the patient experience.

Nice To Haves

Awareness of healthcare reimbursement systems, including HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems.
General understanding of coding and the DRG assignment process.

Responsibilities

Coordinate care and plan transitions throughout the acute-care patient experience.
Collaborate with physicians, utilization managers, medical social workers, bedside RNs, patients, families, and interdisciplinary partners to support timely progression and transitions to appropriate levels of care.
Facilitate communication and care across the continuum through effective resource coordination.
Support optimal health, access to care, appropriate resource utilization, and patients’ self-determination.
Work with internal and external stakeholders, including payers, review agencies, contracted providers, and community resources.
When assigned to the Emergency Department, address complex clinical and social situations efficiently to avoid unnecessary admissions.
Promote quality patient care and a positive patient experience.