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 EXPERIENCE 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:
Once 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 $82.48 to $115.46 / hour
The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.