Case Manager II, Registered Nurse

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

Organization:

CPMC-California Pacific Med Center

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:

• 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.

Job Shift:

Days

Schedule:

Per Diem/Casual

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

No

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

0

Employee Status:

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

Pay Range is $116.31 to $116.31 / hour The posted pay range is based on the position's primary work location. Candidates who reside and work outside of that location may be subject to a different pay range based on their work location. Candidate starting salaries consider 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.