RN Case Manager Managed Care Referrals
RN Case Manager Managed Care Referrals
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Job Description
We are so glad you are interested in joining Sutter Health!
Organization:
SC Sansum ClinicPosition Overview:
Conducts preauthorization concurrent and retrospective utilization management review using the departments accepted criteria for ambulatory acute and postacute patients to confirm medical necessity is met and at the appropriate level of care. Coordinates the utilization management resource management discharge planning postacute 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:
- Graduate of an accredited school of nursing
CERTIFICATION & LICENSURE:
- RNRegistered Nurse of California
- CCM Certified Case Manager certification may be required by entity and time to acquire within 2 years of hire)
TYPICAL EXPERIENCE:
- 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 postacute 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 highvolume 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:
DaysSchedule:
Full TimeShift Hours:
8Days of the Week:
Monday FridayWeekend Requirements:
NoneBenefits:
YesUnions:
NoPosition Status:
NonExemptWeekly Hours:
40Employee Status:
RegularSutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $54.99 to $79.73 / hourThe salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidates experience education skills licensure and certifications department equity training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.
Required Experience:
Manager
Employment Type
Full-Time
