Case Manager II, Registered Nurse

Job Description

Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. 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.

Education

• Graduate of an accredited school of nursing
• RN-Registered Nurse of California
• Certification in Care Management preferred upon hire

Experience

• 5 years recent relevant experience

Skills and Knowledge

• 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
• 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
• Broad knowledge base of post-acute levels of care and associated regulatory compliance requirements
• General understanding of coding and DRG assignment process preferred

Interpersonal Skills

• Ability 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

Work Style

• 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

Schedule

Full Time Shift Hours: 8 Days Of The Week Variable Weekend Requirements: Every other Weekend

Benefits

Yes

Union Status

No

Status

Non-Exempt

Hours

Weekly Hours: 40

Employee Status

Regular

Pay Range

$86.68 to $114.41 / 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.