Case Manager, Registered Nurse

Sutter Health • San Francisco, CA

1d • $87 - $118

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. Works to promote patient wellness, improve care outcomes, use health services efficiently, and minimize payment denials for patients with complex health needs.

Requirements

• A bachelor's degree in Nursing or Health Administration; equivalent experience may be accepted in lieu of the required degree or diploma.
• California Registered Nurse (RN) licensure.
• At least three years of experience in an acute medical/surgical, Emergency Department, or critical care nursing area; a Master's in Nursing in Case Management may be considered in lieu of this experience at the director's discretion.
• Experience conducting clinical assessments for patients with complex medical, emotional, and social needs.
• Experience using an electronic medical record system.
• Excellent interpersonal communication and negotiation skills.
• Broad knowledge of healthcare delivery and case management in a managed care environment.
• Comprehensive knowledge of utilization review, levels of care, and observation status.
• 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.
• Excellent verbal and written communication skills.
• Excellent time-management skills and ability 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 interact effectively with internal and external constituents using collaboration and customer-service skills.

Nice To Haves

• Master's degree in Nursing, Case Management, or a related field.
• Certified Case Manager (CCM) certification.
• Previous Case Management experience.
• Experience using InterQual or other standardized criteria.
• Experience and knowledge with MIDAS.
• Awareness of healthcare reimbursement systems, including HMO, PPO, PPS, and CMS.
• Knowledge of post-acute levels of care, including Home Health, Hospice, AIM, Palliative Care, SNF, LTAC, B&C, Sub-acute, and Acute Rehab.
• General knowledge of coding and the DRG assignment process.

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.
• Promote coordinated and integrated care to prevent unnecessary admissions and readmissions.
• Coordinate discharge planning and interventions for high-risk patients presenting to the Emergency Department.
• Promote patient wellness, improved care outcomes, efficient utilization of health services, and minimized payment denials.

What This Job Offers