RN Case Manager, Acute Rehab

Sutter Health•Oakland, CA

25d•$87 - $114

About The Position

Conducts preauthorization, concurrent, and retrospective utilization management review using the department’s accepted criteria for ambulatory, acute, and post-acute patients to confirm medical necessity is met and at the appropriate level of care. Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. Strives to promote patient wellness, improved care outcomes, and efficient utilization of health services among a patient population with complex health needs.

Requirements

Graduate of an accredited school of nursing
RN-Registered Nurse of California Required
BLS-Basic Life Support Certification Required
Minimum of 2 years recent relevant experience Required
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.
Strong verbal and written communication skills and negotiation skills
Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
Intermediate computer and technology 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

Certified Case Manager (CCM) Preferred
Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems preferred.
General understanding of coding and DRG assignment process preferred.

Responsibilities

Conducts preauthorization, concurrent, and retrospective utilization management review
Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation.
Promotes patient wellness, improved care outcomes, and efficient utilization of health services