Case Manager, Registered Nurse

Sutter Health•San Francisco, CA

11d

About The Position

Coordinates utilization management, resource management, discharge planning, post-acute care referrals, and care facilitation. Oversees acute patient populations across the care continuum, focusing on coordinated and integrated care to prevent unnecessary admissions or readmissions. Coordinates discharge planning and interventions for high-risk patients presenting to the Emergency Department. Promotes patient wellness, improved care outcomes, efficient utilization of health services, and minimized payment denials among patients with complex health needs. This is a per diem/casual, non-exempt position at CPMC-California Pacific Medical Center – Mission Bernal. The schedule is on days, with 8-hour shifts on variable days Monday through Friday and one weekend shift per month. The posted pay range is $87.46 to $118.34 per hour; actual starting pay may vary based on factors including experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Eligible positions include a comprehensive benefits package.

Requirements

Graduate of an accredited school of nursing.
California Registered Nurse (RN) license.
Two years of recent relevant experience.
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 Grouper, Title 22, the CHA Consent Manual, CDPH, and The Joint Commission.
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 ability to support a positive patient experience.
Verbal and written communication skills.
Interpersonal communication and negotiation skills.
Time-management skills to organize work in a high-volume environment with rapidly changing priorities.
Intermediate computer skills.
Ability to promote teamwork and function effectively in teams.
Ability to work effectively with internal and external constituents using collaboration and customer-service skills.

Nice To Haves

Certified Case Manager (CCM) certification is optional.

Responsibilities

Coordinate utilization management, resource management, discharge planning, post-acute care referrals, and care facilitation.
Oversee management of acute patient populations across the care continuum to support coordinated and integrated care and prevent unnecessary admissions or readmissions.
Coordinate discharge planning and interventions for high-risk patients presenting to the Emergency Department.
Promote patient wellness, improved care outcomes, and efficient utilization of health services.
Help minimize payment denials among patients with complex health needs.
Collaborate and communicate with patients, families, caretakers, physicians, nurses, and ancillary partners.