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RN Case Manager Subject Matter Expert 0.8 FTE Days

Job ID CPMC-1913093 Date Posted 09/11/2019 Location San Francisco, California Schedule/Shift Part Time / Day
Position Overview:
The incumbent serves as the Bay Area Operating Unit Case Manager (CM) Subject Matter Expert (SME) performing Case management roles and functions, with a primary focus on InterQual medical necessity reviews, training newly hired team members, quality assurance and support. Additional training may also include discharge planning for newly hired staff. Incumbent must consistently maintain System accuracy and productivity standards. 
Incumbent must have the ability to conduct group and one-on-one training sessions with peers and new hire RN case managers, provide constructive feedback, and assess progress and compliance with the System standardized UM Process and CM workflows. Incumbent must also have the ability to schedule RN Case Manager training sessions, conduct and present audit findings, trends and program results to staff and leaders.
The incumbent works with Bay Area Care Coordination Educators as needed, and may be responsible for adjudicating managed care acute enrollees as assigned by the Director. The incumbent may have contact with patients, families, the interdisciplinary team, nursing management, quality and ancillary services, third party payers and review agencies. The incumbent must develop key relationships with Case Managers, Care Coordination leaders, and Physician Advisors, in addition to maintaining a beneficial working relationship with team members and physician leaders to assist in the clinical review process.



Bachelor's required.  Master's MS in Case Management or related field preferred.

Licensures and Certifications

Certified Case Manager - CCM National Certification in Case Management (ACM, ANA RN-BC Case Management)


Minimum of three (3) years in acute medical-surgical nursing, emergency department or critical care required. Masters of Nursing in Case Management in lieu of three (3) years in acute medical-surgical, emergency department or critical care nursing may be considered for employment at the Director’s discretion required.

Previous Case Management experience preferred.

Experience with providing training, education or as a preceptor preferred.

Experience utilizing electronic health records preferred.

Experience with Midas preferred.

Experience with InterQual or other standardized medical necessity criteria preferred.

Experience in clinical denials management preferred.

Skills and Knowledge

Broad knowledge base of health care delivery and case management within a managed care environment.

Knowledge of utilization review process, OIG, CMS, RAC, and all other regulatory agencies related to utilization management.

Comprehensive knowledge of medical necessity standards, levels of care, inpatient and outpatient status (observation, ambulatory procedure, emergency).

Excellent verbal and written communication skills.

Able to work with team members to produce desired goals and objectives.

Able to successfully navigate multiple computer programs for chart review, medical necessity determination, and care coordination processes.

Able to provide group and one-on-one education to new hires and peers.

Proficient in Excel spreadsheets, use of pivot tables, formulas and graphs.

Proficient in Microsoft Outlook.

Special Requirements

As required, travel to locations within the Bay Area Operating Unit.  

Organization: California Pacific Medical Center
Employee Status: Regular
Employee Referral Bonus: No
Benefits: Yes
Position Status: Non-Exempt
Union: No
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Varied Days
Weekend Requirements: Rotating
Schedule: Part Time
Hrs Per 2wk Pay Period: 64

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

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