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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

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.

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:

Full Time

Shift Hours:

8

Days of the Week:

Variable

Weekend Requirements:

Occasionally

Benefits:

Yes

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

32

Employee Status:

Regular

Employees of Sutter Health and its entities may handle hazardous drugs in the course of their work, including patient care, which requires them to manage, store, prepare, receive, unpack, transport, dispose of, or administer drugs identified as hazardous or potentially hazardous by the National Institute for Occupational Safety and Health (NIOSH) and in accordance with the USP 800 guidelines.

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

Pay Range is $82.95 to $109.48 / hour

_The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package._