Care Manager, Registered Nurse

Sutter Health

Roseville, CAFull-time$82.48–115.46/hrPosted 2w agoVerified open 2 days ago

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At a glance

Compensation

$82.48–115.46/hr

Location

Roseville, CA

Schedule

Full-time

Work Authorization

Not specified

Requirements

Credentials this posting asks for.

RN Registered Nurse Of California

Job overview

Sutter Health is hiring a Care Manager, Registered Nurse. The Care Manager, Registered Nurse at Sutter Health is responsible for care coordination and transitions planning throughout the acute care patient experience, collaborating with physicians, utilization managers, social workers, and bedside nurses to ensure timely progression and appropriate level of care while preventing unnecessary admissions or readmissions.

Key focus areas include Coordinate care transitions and planning throughout acute care patient experience, Collaborate with physicians, utilization managers, medical social workers, and bedside RN to ensure timely patient progression, and Communicate and facilitate care across the continuum through effective resource coordination.

Important skills include Health Care Delivery Knowledge, Case Management Knowledge, Utilization Review Knowledge, Levels Of Care Knowledge, Observation Status Knowledge, and Laws And Regulations Knowledge. Preferred (not required): Healthcare Reimbursement Systems Knowledge, HMO Knowledge, PPO Knowledge, and PPS Knowledge.

Skills & qualifications

RequiredNice to have

Skills

Health Care Delivery KnowledgeCase Management KnowledgeUtilization Review KnowledgeLevels of Care KnowledgeObservation Status KnowledgeHealthcare Reimbursement Systems KnowledgeHMO KnowledgePPO KnowledgePPS KnowledgeCMS KnowledgeValue Based Reimbursement Models KnowledgeAlternative Payment Systems KnowledgeLaws and Regulations KnowledgeCMS Regulations KnowledgeTitle 22 KnowledgeCHA Consent Manual KnowledgeCDPH KnowledgeTJC KnowledgePost Acute Levels of Care KnowledgeRegulatory Compliance KnowledgeCoding and DRG Assignment UnderstandingEffective CommunicationCollaboration SkillsIndependent Work AbilitySound JudgmentService Excellence CommitmentQuality Patient Care FocusVerbal Communication SkillsWritten Communication SkillsNegotiation SkillsTime Management SkillsIntermediate Computer SkillsTeamwork PromotionCustomer Service Skills

Qualifications

Graduate of Accredited School of NursingRN Registered Nurse of California2+ Years Acute Care Case Management Experience2+ Years Health Plan Case Management Experience

Full job description

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

Organization:

SMCS-Valley Administration

Position Overview:

Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through effective resource coordination. The goals of this role are to include the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self –determination while coordinating in a timely and integrated fashion. He/She collaborates with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical and social situations efficiently in order to avoid unnecessary admissions.

Job Description :

EDUCATION:

Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:

RN-Registered Nurse of California Upon Hire

TYPICAL EXPERIENCE:

2 years of experience in acute care case management or health plan case management/utilization management.

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.

#LI-DF1

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

Days of the Week:

Variable

Weekend Requirements:

One Weekend Shift a month

Benefits:

Yes

Unions:

Position Status:

Non-Exempt

Weekly Hours:

Employee Status:

Regular

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

Pay Range is $82.48 to $115.46 / 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.

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