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

Organization:

SMCS-Sutter Med Center - Sacramento

Position Overview:

This position coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. This position oversees the management of acute patient populations across the care continuum with a focus to provide coordinated and integrated care to prevent unnecessary admissions or readmissions. Provides discharge planning coordination and Intervention for the high risk patient presenting to the Emergency Department. This position strives to promote patient wellness, improved care outcomes, efficient utilization of health services and minimized denials of payment among a patient population with complex health needs.

Job Description:

EDUCATION:

Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:

RN-Registered Nurse of California Upon Hire

TYPICAL EXPERIENCE:

2 years recent relevant experience

OR graduate of an accredited Master's degree program in Nursing with a specialization in Case Management

SKILLS AND KNOWLEDGE:

Experience in acute care case management or health plan case management/utilization management.

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.
Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems
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 post-acute levels of care and associated regulatory compliance requirements.
General understanding of coding and DRG assignment process preferred.
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.
Strong verbal and written communication skills and negotiation skills
Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
Intermediate computer and technology 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:

Variable

Weekend Requirements:

Rotating Weekends

Benefits:

Yes

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

32

Employee Status:

Regular

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

Pay Range is $82.48 to $115.46 / 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.