Care Manager, Registered Nurse
Company: Sutter Health
Location: Grass Valley
Posted on: May 11, 2022
Job Description:
Position Overview:Responsible for Care Coordination and Care
Transitions Planning throughout the acute care patient experience.
This positionworks in collaboration with the Physician, Utilization
Manager, Medical Social Worker and bedside RN to assure the
timelyprogression and transition of patients to the appropriate
level of care to prevent unnecessary admissions or readmissions.
TheCare Management process encompasses communication and
facilitates care across the continuum through effective
resourcecoordination.The goals of this role are to include the
achievement of optimal health, access to care, and
appropriateutilization of resources balanced with the patients'
self -determination while coordinating in a timely and integrated
fashion.He/She collaborates with patients, families, physicians,
the interdisciplinary team, nursing management, quality,
ancillaryservices, third party payers and review agencies, claims
and finance departments, Medical Directors, and contracted
providersand community resources. If assigned to the Emergency
Department, the Care Management process is to address
complexclinical and social situations efficiently in order to avoid
unnecessary admissions.Qualifications:Education, Licensure and
Certification Qualifications:
BS in one of following: Nursing or
Health related field required or equivalent education/experience.MS
in Nursing, Case management, or related field Required or
equivalent education/experience.CA RN license required. -Certified
Case Manager (CCM) preferred.Experience Qualifications:
Minimum of three (3) years in acute
medical/surgical/ ED/ critical care nursing area required.Masters
of Nursing in Case Management in lieu of three (3) years in acute
medical/surgical/ ED/ or critical care nursing area may be
considered for employment at director's discretion.Previous Case
Management experience preferred.Experience utilizing electronic
InterQual or other standardized criteria strongly
preferred.Experience with clinical assessment for patient with
complex medical, emotional and social needs.Experience using an
electronic medical record system.Experience and knowledge with
MIDAS and Allscripts preferred.Skills and Knowledge Qualifications:
-
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
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. -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.Organization:Sutter Valley
HospitalEmployee Status: RegularBenefits: NoPosition Status:
Non-ExemptUnion: NoJob Shift: VariableShift Hours:8 Hour ShiftDays
of the Week Scheduled:Varied DaysWeekend Requirements: One Weekend
a MonthSchedule: Per DiemHrs Per 2wk Pay Period:Per
DiemApplications Accepted:All Applications AcceptedSchedule/Shift:
Per Diem/ Variable
Keywords: Sutter Health, Roseville , Care Manager, Registered Nurse, Executive , Grass Valley, California
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