RN Case Manager

We are so glad you are interested in joining Sutter Health!

Organization:

PAMF-Palo Alto Medical Foundation PAD

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:

* Associate Degree in Nursing

* Other:
Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:

* RN-Registered Nurse of California

* CCM - Certified Case Manager (certification may be required by entity and time to acquire within 2 years of hire)

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), Department of Managed Health Care, National Committee for Quality Assurance (NCQA).

* A broad knowledge base of outpatient, acute, and 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.

* 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.

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

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $82.55 to $108.96 / 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.