Care Manager, Registered Nurse

Sutter Health•Sacramento, CA

8d•$82 - $115

About The Position

Responsible for care coordination and care transitions planning throughout the acute care patient experience. The Care Manager collaborates with the Physician, Utilization Manager, Medical Social Worker, and bedside RN to support timely progression and transition to the appropriate level of care and help prevent unnecessary admissions or readmissions. The role coordinates resources and communication across the continuum to support optimal health, access to care, appropriate resource utilization, and patients’ self-determination. The position works with patients, families, physicians, interdisciplinary teams, nursing management, quality, ancillary services, third-party payers and review agencies, claims and finance departments, Medical Directors, contracted providers, and community resources. When assigned to the Emergency Department, the role addresses complex clinical and social situations efficiently to help avoid unnecessary admissions.

Requirements

Graduate of an accredited school of nursing.
California Registered Nurse (RN) license upon hire.
Two years of recent relevant experience, or graduation from an accredited master's degree program in Nursing with a specialization in Case Management.
Experience in acute care case management or health plan case management/utilization management.
Broad knowledge of health care delivery and case management in a managed care environment.
Comprehensive knowledge of Utilization Review, levels of care, and observation status.
Awareness of healthcare reimbursement systems, including HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems.
Working knowledge of laws, regulations, and professional standards affecting case management practice 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 and quality patient care and a positive patient experience.
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 interact effectively with internal and external constituents using collaboration and customer service skills.

Nice To Haves

General understanding of coding and the DRG assignment process.

Responsibilities

Coordinate patient care and plan transitions throughout the acute care experience.
Collaborate with physicians, utilization management, medical social work, bedside nursing, and other partners to support timely progression to the appropriate level of care.
Coordinate communication and resources across the care continuum.
Support optimal health, access to care, appropriate resource utilization, and patient self-determination.
Work with patients, families, physicians, interdisciplinary teams, nursing management, quality, ancillary services, payers, review agencies, claims and finance departments, Medical Directors, contracted providers, and community resources.
When assigned to the Emergency Department, address complex clinical and social situations efficiently to avoid unnecessary admissions.