Care Manager, Registered Nurse

Sutter Health•Roseville, CA

About The Position

This position is responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. The role involves collaboration with physicians, utilization managers, medical social workers, and bedside RNs to ensure timely patient progression and transition to the appropriate level of care, aiming to prevent unnecessary admissions or readmissions. The Care Management process focuses on communication and facilitating care across the continuum through effective resource coordination. Key goals include achieving optimal health, access to care, and appropriate utilization of resources, balanced with patient self-determination, all coordinated in a timely and integrated fashion. The Care Manager 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 specifically addresses complex clinical and social situations efficiently to avoid unnecessary admissions.

Requirements

Graduate of an accredited school of nursing
RN-Registered Nurse of California Upon Hire
2 years recent relevant experience
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
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
Ability 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
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

Nice To Haves

Bachelor's in Nursing preferred
Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems preferred
General understanding of coding and DRG assignment process preferred

Responsibilities

Perform Care Coordination and Care Transitions Planning throughout the acute care patient experience.
Work 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.
Encompass communication and facilitate care across the continuum through effective resource coordination.
Achieve optimal health, access to care, and appropriate utilization of resources balanced with the patients' self –determination while coordinating in a timely and integrated fashion.
Collaborate 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, address complex clinical and social situations efficiently in order to avoid unnecessary admissions.