Sutter Health RN Case Manager - Clinical Resource Management Full Time Day Shift in Oakland, California
The RN Case Manager is responsible for Care Coordination, Care Transitions, Discharge Planning and Utilization Management throughout the acute care patient experience. The RN Case Manager works in collaboration with the Physician, Medical Social Worker and bedside RN to assure the timely movement of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. Oversees the management of acute patient populations across the care continuum with the primary focus to provide coordinated, timely and integrated care. The RN Case Manager reports to either the Supervisor or Manager or Director of Care Coordination in each facility. The RN Case Manager has frequent contact with patients, families, physicians, the interdisciplinary team, nursing management, quality, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources.
BS in one of following: Nursing or Health related field
MS in Nursing, Case management, or related field
National Certification in Case Management (ACM, ANA RN-BC Case Management)
or Equivalent Ed/Exp
Minimum of three (3) years in acute medical/surgical/ED/ or 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 directors discretion.
Previous Case Management experience preferred.
Experience utilizing electronic InteQrual 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 preferred
Excellent interpersonal communication and negotiation skills.
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.
Some awareness of healthcare reimbursement systems: HMO, PPO, PPS,CMS preferred.
Post-acute levels of care such as Home Health, Hospice, AIM, and Palliative Care. SNF, LTAC, B&C, Sub-acute, Acute rehab.
General Knowledge 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.
Excellent verbal and written communication skills.
Must have excellent 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.
Adheres to Sutter Health policies and procedures and supports Sutter Health philosophies and initiatives.
Primary Location: California, East Bay, Oakland
Organization: Alta Bates Summit Medical Center
Employee Status: Regular
Employee Referral Bonus: No
Position Status: Non-Exempt
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Monday-Friday
Weekend Requirements: Every Other Weekend
Schedule: Full Time
Hrs Per 2wk Pay Period: 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.