RN Care Manager II: Utilization & Care Transitions

Sutter Health; United States; Remote; USD 114,000 - 159,000; Full time

Job summary

Sutter Health is seeking an experienced Utilization Management nurse to ensure the right care is provided at the right time and place. The role involves evaluating admission appropriateness, level of care, and facilitating care transitions in collaboration with the care team, patients, families, and payers.

The position requires a California-licensed RN, with experience in UM, care coordination, and proficiency in InterQual/MCG criteria.

Qualifications

• Graduate of an accredited school of nursing.
• RN-Registered Nurse of California Upon Hire.
• 2 years recent relevant experience.

Responsibilities

• Facilitates utilization management processes to ensure appropriate admission and level of care.
• Performs concurrent review and coordinates care transitions.
• Provides third-party payer clinical information to support reimbursement.
• Collaborates with the treatment team, patient, family, and others as needed.
• Maintains knowledge of regulatory requirements and coding/DRG processes.

Skills

Utilization management knowledge

Care coordination

Effective communication

English literacy

Education

RN - Registered Nurse

California licensure

Tools

InterQual

MCG

Microsoft Office

Job description

Sutter Health is seeking an experienced Utilization Management nurse to ensure the right care is provided at the right time and place. The role involves evaluating admission appropriateness, level of care, and facilitating care transitions in collaboration with the care team, patients, families, and payers.

The position requires a California-licensed RN, with experience in UM, care coordination, and proficiency in InterQual/MCG criteria.