Organization:SHSO-Sutter Health System Office-Valley
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
Pay Range is $78.91 to $103.37 / 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.
