Posted

30+ days ago

Location

Castro Valley, CA

Description

Position Overview:


Responsible for Care Coordination and Care Transitions Planning throughout the acute care patient experience. This position works in collaboration with the Physician, Utilization Manager, Medical Social Worker and bedside RN to assure the timely progression and transition of patients to the appropriate level of care to prevent unnecessary admissions or readmissions. The Care Management process encompasses communication and facilitates care across the continuum through effective resource coordination. The goals of this role are to include the achievement of optimal health, access to care, and appropriate utilization 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, ancillary services, third party payers and review agencies, claims and finance departments, Medical Directors, and contracted providers and community resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical and social situations efficiently in order to avoid unnecessary admissions.


Qualifications:


Education

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.


Licensures and Certifications

CA RN license required. Certified Case Manager (CCM) preferred.


Experience

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 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

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: California Pacific Medical Center

Employee Status: Regular

Employee Referral Bonus: No

Benefits: No

Position Status: Non-Exempt

Union: No

Job Shift: Evening/Night

Shift Hours: 12 Hour Shift

Days of the Week Scheduled: Varied Days

Weekend Requirements: Every Other Weekend

Schedule: Per Diem

Hrs Per 2wk Pay Period: Per Diem

Applications Accepted: All Applications Accepted


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.

About the Company

Sutter Health

Sutter Health has a long history in California. Some of our facilities have been providing care in the communities we serve for more than 100 years. Today, we’re proud to partner with more than 12,000 doctors to care for more than 3 million people.

We’re inspired by our Northern California community and work tirelessly to deliver top-rated, affordable healthcare. Doctors, hospitals, care teams and employees in the Sutter Health network are always looking for new, meaningful ways to care for you and your loved ones. We believe that every moment matters when it comes to helping you live a longer, healthier and happier life.

Our not-for-profit network delivers top-rated, personalized care in more than 100 Northern California communities. Recently ranked among the Top 15 Health Systems in the nation by Truven Health Analytics™, our team of more than 50,000 doctors, employees and volunteers partner to spread innovation, improve access to healthcare services and put our patients’ needs first—all to achieve the highest levels of quality, access and affordability.

Company Size

10,000 employees or more

Industry

Healthcare Services

Employee Benefits

Professional Development, Life Insurance, Vacation/paid time off, Flexible Spending Accounts, Medical, Dental and Vision, 401K, Retirement / Pension Plans, Long Term Disability, Tuition Reimbursement

Founded

1921

Website

https://jobs.sutterhealth.org/