Organization:
Sutter Health Alliance - Valley

Position Overview:
The Medical Management Program Manager RN is a clinically experienced registered nurse leader dedicated to providing concierge-level medical management support to a large employer group client of the health plan. This position serves as the liaison and primary point of contact for the employer client, ensuring a responsive and high-quality service experience through timely communication, proactive issue resolution, and consistent relationship management. The ideal candidate brings demonstrated experience in utilization management and case management functions, with the ability to apply that clinical and operational expertise directly in service of the employer group and its members.

Core responsibilities include responding to client inquiries within twenty-four (24) hours and providing any necessary follow-up within five (5) business days. The Medical Management Liaison RN coordinates across internal health plan departments and operational teams to address plan member healthcare issues, facilitate complaint resolution, support medical appeals, and communicate changes to plan policies and procedures. Working knowledge of utilization management processes and case management principles is essential to effectively navigating member-level issues, supporting appropriate level-of-care determinations, and identifying opportunities to connect members with available clinical resources and programs.

This role manages the day-to-day client relationship with professionalism and accountability, ensuring the employer group receives seamless, coordinated support across all components of the medical management program. The Medical Management Liaison RN serves as a trusted bridge between the employer group and the health plan, advocating for the timely resolution of member issues while ensuring alignment with plan policies, regulatory requirements, accreditation standards, and contractual obligations.

Maintains detailed program documentation, including project plans, status trackers, and meeting minutes, in accordance with departmental standards; proactively identifies and communicates risks to project timelines. Must be able to assess and interpret quality and program performance data, translating findings into clear reports and written narratives suitable for operational, committee, and executive audiences.
Minimum qualifications: 3 years of utilization and case management experience and 3 years of program management experience, either in a managed care or health plan setting. Project Management Professional (PMP) or Program Management Professional (PgMP) certification strongly desired.

Job Description:

EDUCATION:

• Graduate of an accredited school of nursing
• Master's degree preferred

CERTIFICATION & LICENSURE:

• RN- Registered Nurse of California
• BLS- Basic Life Support

TYPICAL EXPERIENCE:

• 5 years recent relevant experience
• 3 years of utilization and case management experience and 3 years of program management experience, either in a managed care or health plan setting is highly desired
• Project Management Professional (PMP) or Program Management Professional (PgMP) certification strongly desired.

SKILLS AND KNOWLEDGE:

• Current working knowledge of program area
• Program management experience
• Excellent skills in written and verbal communication to explain sensitive information clearly and professionally to diverse audiences, including non-medical personnel
• Ability to build collaborative relationships with peers and other healthcare providers and systems to achieve programmatic objectives
• Evidence of problem-solving ability
• Effective leadership and communication (interpersonal, written and verbal) skills

Job Shift:
Days

Schedule:
Full Time

Days of the Week:
Monday - Friday

Weekend Requirements:
None

Benefits:
Yes

Unions:
No

Position Status:
Exempt

Weekly Hours:
40

Employee Status:
Regular

Pay Range is $181,833.60 to $238,201.60 / annual salary

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.