Case Manager, Registered Nurse

Sutter Health•San Francisco, CA

4d•$85 - $114•Onsite

About The Position

The RN Case Manager is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience. The RN Case Manager works in collaboration with the Physician, Medical Social Worker and bedside RN to assure the timely movement of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. Oversees the management of acute patient populations across the care continuum with the primary focus to provide coordinated, timely and integrated care. The RN Case Manager reports to either the Supervisor or Manager or Director of Care Coordination in each facility. The RN Case Manager has frequent contact 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.

Requirements

RN-Registered Nurse of California (required)
Minimum of three (3) years in acute medical/surgical/ED/ or critical care nursing area required.
Experience utilizing electronic InteQrual or other standardized criteria strongly preferred.
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.
Post-acute levels of care such as Home Health, Hospice, AIM, and Palliative Care.
SNF, LTAC, B&C, Sub-acute, Acute rehab.
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

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 and knowledge with MIDAS preferred
Some awareness of healthcare reimbursement systems: HMO, PPO, PPS,CMS preferred.
General Knowledge of coding and DRG assignment process preferred.

Responsibilities

Care Coordination
Care Transitions
Discharge Planning
Utilization Management
Assure the timely movement of patients to the appropriate level of care to prevent unnecessary admissions or readmissions
Oversees the management of acute patient populations across the care continuum with the primary focus to provide coordinated, timely and integrated care