Case Manager, Registered Nurse

Sutter Health•San Francisco, CA

7d•$85 - $114•Onsite

About The Position

Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. Oversees the management of acute patient populations across the care continuum with a focus to provide coordinated and integrated care to prevent unnecessary admissions or readmissions. Provides discharge planning coordination and Intervention for the high risk patient presenting to the Emergency Department. Strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimized denials of payment among a patient population with complex health needs.

Requirements

RN-Registered Nurse of California (required)
Minimum of three (3) years in acute medical/surgical/ED/ or critical care nursing area required.
Experience with clinical assessment for patient with complex medical, emotional and social needs.
Experience using an electronic medical record system
Excellent interpersonal communication and negotiation skills.
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.
Must be able 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.
Excellent verbal and written communication skills.
Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
Intermediate computer 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

Master's in nursing, case management or related field preferred.
CCM-Certified Case Manager (preferred)
Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED/ or critical care nursing area may be considered for employment at directors discretion.
Previous Case Management experience preferred.
Experience utilizing electronic InteQrual or other standardized criteria strongly preferred.
Experience and knowledge with MIDAS preferred
Some awareness of healthcare reimbursement systems: HMO, PPO, PPS,CMS preferred.
Post-acute levels of care such as Home Health, Hospice, AIM, and Palliative Care. SNF, LTAC, B&C, Sub-acute, Acute rehab.
General Knowledge of coding and DRG assignment process preferred.

Responsibilities

Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation.
Oversees the management of acute patient populations across the care continuum with a focus to provide coordinated and integrated care to prevent unnecessary admissions or readmissions.
Provides discharge planning coordination and Intervention for the high risk patient presenting to the Emergency Department.
Strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimized denials of payment among a patient population with complex health needs.