Case Manager Ii, Utilization Management

Organization:

PAMF-Sutter Maternity and Surg Ctr

Position Overview:

Coordinates the Utilization Management, resource management, discharge planning, post-acute care referrals and care facilitation. 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. 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:

These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).
EDUCATION:
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 may be dependent on qualifications for exam)
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), Title 22, CHA Consent Manual, California Department of Public Health (CDPH) and The Joint Commission (TJC).
A broad knowledge base of 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 patient, 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.
PHYSICAL ACTIVITIES AND REQUIREMENTS:
See required physical demands, mental components, visual activities & working conditions at the following link: Job Requirements

Job Shift:

Varied

Schedule:

Per Diem/Casual

Shift Hours:

6

Days of the Week:

Variable

Weekend Requirements:

Saturday

Benefits:

No

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

0

Employee Status:

Per Diem/Casual

Number of Openings:

1

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

Pay Range is $101.87 to $101.87 / hour