Case Manager II, Acute RN

Sutter Health; Oakland (CA); On-site; USD 125,000 - 175,000; Full time

Benefits offered by this job

Benefits package

Job summary

Sutter Health is seeking an RN Care Manager to oversee care coordination and transitions planning across the acute care patient journey. You will collaborate with physicians, utilization managers, social workers, and bedside nurses to ensure timely progression and appropriate care levels, reducing avoidable admissions.

The role emphasizes strong communication, regulatory knowledge, and a commitment to quality patient experiences.

Qualifications

• Broad knowledge of health care delivery and case management within a managed care environment.
• Understanding of Utilization Review, levels of care, and observation status.
• Familiarity with CMS, Title 22, CHA, and other regulatory standards.

Responsibilities

• Coordinate care transitions across the acute care continuum.
• Collaborate with physicians, case managers, social workers, and nursing staff to assure timely progression and appropriate utilization of resources.
• Address complex clinical and social situations, especially in the ED, to avoid unnecessary admissions.
• Promote quality patient care and an excellent patient experience through effective communication and teamwork.

Skills

Care coordination

Utilization review

Communication

Time management

Teamwork

Regulatory compliance

Documentation

Problem solving

Clinical reasoning

Patient advocacy

Education

Master's degree in Nursing (Case Management)

RN license California

Tools

Electronic Health Records

Job description

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

Organization:

CPMC-California Pacific Med Center

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.

Job Description :

EDUCATION:

• Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:

• RN-Registered Nurse of California Required

TYPICAL EXPERIENCE:

• Two years recent relevant experience
• OR Graduate of an accredited Master's degree program in Nursing with a specialization in Case Management

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:

Rotating Weekends

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 $90.58 to $126.81 / hour

The posted pay range is based on the position's primary work location. Candidates who reside and work outside of that location may be subject to a different pay range based on their work location. Candidate starting salaries consider 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.