• Job Description

  Req#: R-118110

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

  Organization:

  SHSO-Sutter Health System Office-Bay

  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 $90.75 to $118.88 / 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.

• About the company

  Sutter Health is a not-for-profit integrated health delivery system headquartered in Sacramento, California.

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