RN Case Manager, Acute Rehab

Sutter Health•Oakland, CA

15h•$87 - $114

About The Position

We are so glad you are interested in joining Sutter Health! Organization: ABSMC-Summit Campus Position Overview: 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. Job Description : EDUCATION: Graduate of an accredited school of nursing CERTIFICATION & LICENSURE: RN-Registered Nurse of California Required BLS-Basic Life Support Certification Required Certified Case Manager (CCM) Preferred TYPICAL EXPERIENCE: Minimum of 2 years recent relevant experience Required SKILLS AND KNOWLEDGE: 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. Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems preferred. Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC. A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements. General understanding of coding and DRG assignment process preferred. 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. Job Shift: Days Schedule: Part Time Shift Hours: 8 Days of the Week: Variable Weekend Requirements: Occasionally Benefits: Yes Unions: No Position Status: Non-Exempt Weekly Hours: 24 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $86.68 to $114.41 / hour The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.

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.
Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system: including but not limited to: CMS, Title 22, CHA Consent Manual, CDPH and TJC.
A broad knowledge base of post-acute levels of care and associated regulatory compliance requirements.
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 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.