RN Case Manager, Managed Care Referrals - Sutter Health
Goleta, CA
About the Job
Organization:
SC - Sansum Clinic
Position Overview:
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.
Job Description :
EDUCATION:
+ Other: Graduate of an accredited school of nursing
CERTIFICATION & LICENSURE:
+ RN-Registered Nurse of California
+ BLS-Basic Life Support Healthcare Provider
+ CCM - Certified Case Manager (certification may be required by entity and time to acquire may be dependent on qualifications for exam)
TYPICAL EXPERIENCE:
+ 2 years recent relevant experience
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.
Working knowledge of laws, regulations and professional standards affecting case management practice in an integrated delivery system: including but not limited to: Centers for Medicare and Medicaid Services (GR) Grouper (CMS), Title 22, CHA Consent Manual, California Department of Public Health (CDPH) and The Joint Commission (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 patient, 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.
Verbal and written communication skills.
Interpersonal communication and negotiation skills.
Must have 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.tal components, visual activities & working conditions at the following link: Job Requirements (https://sutterhealth.sharepoint.com/:b:/s/JobAnalysisLibrary/ET7uGCe-tzVGh0qew2nHBZsBpR4VIJFStf2B53bAii2JrA?e=M78vhR)
Job Shift:
Days
Schedule:
Full Time
Shift Hours:
8
Days of the Week:
Monday - Friday
Weekend Requirements:
None
Benefits:
Yes
Unions:
No
Position Status:
Non-Exempt
Weekly Hours:
40
Employee Status:
Regular
Number of Openings:
1
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $54.99 to $79.73 / hour
_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
SC - Sansum Clinic
Position Overview:
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.
Job Description :
EDUCATION:
+ Other: Graduate of an accredited school of nursing
CERTIFICATION & LICENSURE:
+ RN-Registered Nurse of California
+ BLS-Basic Life Support Healthcare Provider
+ CCM - Certified Case Manager (certification may be required by entity and time to acquire may be dependent on qualifications for exam)
TYPICAL EXPERIENCE:
+ 2 years recent relevant experience
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.
Working knowledge of laws, regulations and professional standards affecting case management practice in an integrated delivery system: including but not limited to: Centers for Medicare and Medicaid Services (GR) Grouper (CMS), Title 22, CHA Consent Manual, California Department of Public Health (CDPH) and The Joint Commission (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 patient, 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.
Verbal and written communication skills.
Interpersonal communication and negotiation skills.
Must have 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.tal components, visual activities & working conditions at the following link: Job Requirements (https://sutterhealth.sharepoint.com/:b:/s/JobAnalysisLibrary/ET7uGCe-tzVGh0qew2nHBZsBpR4VIJFStf2B53bAii2JrA?e=M78vhR)
Job Shift:
Days
Schedule:
Full Time
Shift Hours:
8
Days of the Week:
Monday - Friday
Weekend Requirements:
None
Benefits:
Yes
Unions:
No
Position Status:
Non-Exempt
Weekly Hours:
40
Employee Status:
Regular
Number of Openings:
1
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $54.99 to $79.73 / hour
_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.
Source : Sutter Health