RN Case Manager, Acute Rehab in Oakland, CA

We are so glad you are interested in joining Sutter Health! Organization: ABSMC-Summit Campus 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: • Graduate of an accredited school of nursing CERTIFICATION & LICENSURE: • RN-Registered Nurse of California Required • BLS-Basic Life Support Certification Required • Certified Case Manager (CCM) Preferred TYPICAL EXPERIENCE: • Minimum of 2 years recent relevant experience Required 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. • Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based 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 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: Part Time Shift Hours: 8 Days of the Week: Variable Weekend Requirements: Occasionally Benefits: Yes Unions: No Position Status: Non-Exempt Weekly Hours: 24 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $86.68 to $114.41 / 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.