Case Manager II, Acute RN

Sutter Health•Oakland, CA

23h•$91 - $127

About The Position

Responsible for care coordination and care transitions planning throughout the acute care patient experience. The Case Manager works in collaboration 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. The care management process coordinates communication and resources across the continuum, supporting optimal health, access to care, appropriate resource utilization, and patient self-determination through timely, integrated coordination. The role 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 required.
Two years of recent relevant experience, or graduation from an accredited master's degree program in Nursing with a specialization in Case Management.
Broad knowledge of healthcare 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 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 with patients, families, and employees and in performing job responsibilities.
Ability to promote quality patient care and a positive patient experience.
Strong verbal, written communication, and negotiation skills.
Excellent time-management skills and ability to develop organized work processes 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

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 care transitions throughout the acute care patient experience.
Collaborate with physicians, Utilization Managers, Medical Social Workers, bedside RNs, and other stakeholders to support timely progression to the appropriate level of care.
Help prevent unnecessary admissions and readmissions through effective resource coordination.
Facilitate communication and coordinate care across the continuum while supporting access to care, optimal health, appropriate resource utilization, and patient self-determination.
Collaborate 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.