Case Manager, Registered Nurse

Sutter Health•San Francisco, CA

13d•$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. Provides discharge planning coordination and intervention for high-risk patients presenting to the Emergency Department. Promotes patient wellness, improved care outcomes, efficient use of health services, and minimized payment denials among patients with complex health needs.

Requirements

Graduate of an accredited school of nursing.
California Registered Nurse (RN) licensure.
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 other ancillary partners.
Ability to work independently and exercise sound judgment in interactions with physicians, payers, patients, and families.
Commitment to service excellence and 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 collaborate effectively with internal and external constituents using customer service skills.

Nice To Haves

Certified Case Manager (CCM) certification (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.
Promote coordinated and integrated care to prevent unnecessary admissions or readmissions.
Coordinate discharge planning and intervene for high-risk patients presenting to the Emergency Department.
Promote patient wellness, improved care outcomes, efficient utilization of health services, and minimized payment denials.