Care Manager II Utilization Management

We are so glad you are interested in joining Sutter Health!

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

This position facilitates utilization management (UM) processes to support that the right care is provided at the right place and at the right time. To accomplish these goals, he/she applies established criteria to evaluate the appropriateness of admission, level of care, continued hospitalization and readiness for care transition; assures timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as necessary; in collaboration with the Facility Acute Care Manager (CM). This position provides third-party payers clinical information to assure reimbursement; and coordinating care with the treatment team, patient, family and others as necessary.

Job Description:

EDUCATION:

• Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:

• RN-Registered Nurse of California Upon Hire

PREFERRED EXPERIENEC AS TYPICALLY ACQUIRED IN:

• 2 years recent relevant experience.

SKILLS AND KNOWLEDGE:

• Demonstrates basic knowledge of the role of UM, Care Transition and/or CM for patients within an acute hospital and/or ED setting and across the continuum of care. This will be assessed during the interview process and the candidates narrative answers to case scenarios.

• Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, all 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.

• Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.

• Demonstrates ability to efficiently and independently manage own time and tasks with minimal supervision.

• General understanding of coding and DRG assignment process preferred.

• Excellent verbal and written communication skills required.

• Must be able to communicate effectively with a wide variety of personalities and departments, including members of the medical staff.

• Ability to read, write, hear, and communicate verbally in English to the degree required to perform the job.

• Willingness to act and dress in a professional manner at all times.

• Proficient in using a computer to accurately enter and extract data, send and receive email, calendar appointments, and use task lists associated with a a variety of computer software programs.

• Proficient in the use and application of evidence-based level of care and medical necessity criteria such as InterQual and/or MCG.

• Must be able to meet accuracy and productivity requirements by the organization standards.

• Maintain proficiency in conducting utilization reviews using MCG/InterQual by keeping up with practices and technology, participating in all training and education requirements, and certification or accreditation as applicable.

• Ability to use Microsoft Office Suite products (Outlook, Word, Excel, Power Point) preferred.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

One Weekend Shift a month

Benefits:

Yes

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

40

Employee Status:

Regular

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

Pay Range is $75.53 to $98.92 / 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. ​