RN Case Manager

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

Organization

PAMF-Palo Alto Medical Foundation PAD

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

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

Pay Range is $82.55 to $108.96 / 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.