Care Manager II, Utilization Mgmt Acute

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

Organization:

SHSOSutter Health System OfficeValley

Position Overview:

This position facilitates utilization management (UM) processes to support that the right care is provided at the right place and at the right time. To accomplish these goals he/she applies established criteria to evaluate the appropriateness of admission level of care continued hospitalization and readiness for care transition; assures timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care service or transition of care delays/issues as necessary; in collaboration with the Facility Acute Care Manager (CM). This position provides thirdparty payers clinical information to assure reimbursement; and coordinating care with the treatment team patient family and others as necessary.

Job Description:

EDUCATION:

• Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:

• RNRegistered Nurse of California Upon Hire

PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN:

• 2 years recent relevant experience.

SKILLS AND KNOWLEDGE:

• Demonstrates basic knowledge of the role of UM Care Transition and/or CM for patients within an acute hospital and/or ED setting and across the continuum of care. This will be assessed during the interview process and the candidates narrative answers to case scenarios.

• Awareness of healthcare reimbursement systems: HMO PPO PPS CMS all valuebased 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 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.

• Demonstrates ability to efficiently and independently manage own time and tasks with minimal supervision.

• General understanding of coding and DRG assignment process preferred.

• Excellent verbal and written communication skills required.

• Must be able to communicate effectively with a wide variety of personalities and departments including members of the medical staff.

• Ability to read write hear and communicate verbally in English to the degree required to perform the job.

• Willingness to act and dress in a professional manner at all times.

• Proficient in using a computer to accurately enter and extract data send and receive email calendar appointments and use task lists associated with a a variety of computer software programs.

• Proficient in the use and application of evidencebased level of care and medical necessity criteria such as InterQual and/or MCG.

• Must be able to meet accuracy and productivity requirements by the organization standards.

• Maintain proficiency in conducting utilization reviews using MCG/InterQual by keeping up with practices and technology participating in all training and education requirements and certification or accreditation as applicable.

• Ability to use Microsoft Office Suite products (Outlook Word Excel Power Point) preferred.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday Friday

Weekend Requirements:

Once a Month

Benefits:

Yes

Unions:

No

Position Status:

NonExempt

Weekly Hours:

40

Employee Status:

Regular

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

Pay Range is $75.53 to $98.92 / hour

The 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.