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Temporary contract opportunities at Sutter Health
In Partnership with RightSourcing – Managed Service Provider for Sutter Health

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Care Coordination Representative

Job ID CWP-2121533 Date Posted 11/17/2021 Location Sacramento, California Schedule/Shift Temporary/Contract/ Day

Thank you for your interest in temporary contract opportunities with RightSourcing at Sutter Health and wanting to assist our team that proudly cares for more than 3 million of our neighbors across Northern California.


Position Overview:
The Care Coordination Representative demonstrates the ability to read, comprehend, understand and interpret complex medical guidelines to determine if appropriate information has been provided in utilization reviews before transmission to external payers for review of medical necessity for Inpatient admission. The care coordination representative uses effective interpersonal skills in supporting the complex interactions involved in communicating with the Care Coordination staff, the payers, internal and external departments within the organization and other vendors.

Qualifications:

Education: High School Diploma/GED required. AA/AS degree or equivalent combination of education and experience desired. Related field or equivalent experience in health care required
Related course work in business and computer skills desired

Experience & Knowledge:
• Working knowledge of medical terminology, ICD-9, CPT Codes, HCPCS
• Knowledge of level of care including criteria required for payment and applications processes
• Knowledge of the healthcare industry and available healthcare programs and resources
• General knowledge of illnesses, current treatments and their physical and psychological sequelae
• Ability to accurately interpret contractual and financial payer risk information
• Experience within a health care setting is preferred as well as within an healthcare insurance experience
• Experience in a Billing / Coding or medical office environment is helpful
• Experience with reading, comprehending, and understanding complex medical guidelines is fundamental
• Experience and ability to maintain federal and state regulatory requirements including NCQA, CMS/HCFA, and DMHC
• Experience of data collection techniques and methods of analyzing and reporting data

Special Skills/Equipment:
• PC proficiency in word processing, spreadsheets, graphics, flow charts, organizational charts, and database software required
• Microsoft products preferred (i.e. Windows, Word, Excel, Power point, Access, Outlook)
• Excellent interpersonal skills and time management skills, ability to work efficiently in a fast pace environment, with rapidly shifting priorities and competing demands.
• Ability to work independently with minimal supervision. Ability to exercise discretion and make independent judgments, seeking review when decisions represent significant departure from established guidelines.
• Excellent oral and written communication
• Ability to work in a confidential setting
• Ability to multitask
• Organizational and teamwork skills
• Attention to detail

• Ability to work with frequent interruptions and minimal supervision
• Must be able to work in a demanding, fast paced environment balancing multiple priorities and take appropriate actions in challenging situations
• Knowledge of the Sutter Health organization is desired 



Organization:Sutter Health System Office
Employee Status: Temporary
Position Status: Non-Exempt
Union: No
Job Shift: Day
Shift Hours:8 Hour Shift
Days of the Week Scheduled:Monday-Friday
Weekend Requirements: None
Schedule: Temporary/Contract
Hrs Per 2wk Pay Period:80

Sutter Health Affiliates are equal opportunity employers EOE/M/F/Disability/Veterans

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