RN Case Manager Subject Matter Expert 0.8 FTE DaysJob ID CPMC-1913093 Date Posted 09/11/2019 Location San Francisco, California Schedule/Shift Part Time / Day
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.
As required, travel to locations within the Bay Area Operating Unit.
Employee Status: Regular
Employee Referral Bonus: No
Position Status: Non-Exempt
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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