Case Manager - Santa Rosa Manager Care

Employer
CA, United States
Job Summary
col-narrow
License: RN - Registered Nurse
Specialty: Case Management, General
Location: Santa Rosa, CA
Employment Type: Full time
Job Description
col-wide
At Sutter Health, our partnerships help us transform care. We are more than 50,000 professionals who are strengthened by compassion, inspired by innovation, and driven to excellence.  If you’re ready to add your abilities to our broad network of care, come realize your professional potential with Sutter Health.
 
Case Manager - Santa Rosa Managed Care
(80hr Days)
 
Sutter Pacific Medical Foundation is a not for profit corporation that exists to provide medical services, research and education. The foundation provides the infrastructure for the delivery of physician services, and contracts with a separate corporation comprised of physicians and other care providers to deliver the clinical services. This multi-specialty foundation will provide a platform from which new physicians can be recruited to continue to provide physician services in a nonprofit, community setting. The Foundation's vision is to create a medical group that will deliver high quality, market competitive medical services.
 
The Case Manager, RN is responsible for the identification of needs, evaluation and coordination of all health care services provided to Sutter Medical Group of the Redwoods managed care population. The Case Manager facilitates the arrangement and delivery of services throughout the continuum of care, while educating physicians and ancillary staff regarding the appropriate utilization of health care resources. The incumbent functions as a physician advisor with accountability to escalate cases to medical leadership as necessary. The Case Manager performs concurrent and retrospective review to determine the medical appropriateness of levels of care. The role is responsible for coordinating certain operations of Disease Management Programs.

Qualifications
Education Licensures and Certifications:
  • Graduate of an accredited school of nursing.
  • Current license as a registered nurse in the State of California
  • BSN preferred.
Experience:
  • Two-three years recent experience in Utilization Management/Case Management in acute setting or in a managed care setting, i.e., HMO or medical group required.
Skills and Knowledge:
  • NCQA standards and application, state and federal requirements as apply to managed care, utilization management criteria and its application, i.e., InterQual, Milliman & Robertson.
  • Ability to work independently, organize priorities and manage multiple assignments, excellent communication and interpersonal skills, critical thinking and problem-solving skills.
  • Computer experience is desirable.
 
To learn more and apply, please visit: https://jobs.sutterhealth.org/job/santa-rosa/case-manager-santa-rosa-managed-care-80hr-days/1099/4819541
 
Sutter Health Affiliates are Equal Opportunity Employers.  Sutter Health is an Equal Opportunity Employer (EOE M/F/D)
 
It is the policy of Sutter Health and its affiliates to provide equal employment for all qualified individuals; to prohibit discrimination in employment because of race, color, creed, religion, marital status, sex, sexual orientation, gender identity, ancestry, national origin, age, medical condition, disability or status as a veteran or a disabled veteran. We promote the full realization of equal employment opportunities through a positive continuing program within each company, hospital, department, and service area. Equal employment opportunities apply to every aspect of Sutter Health's employment policies and practices.
 

Company Info


Sutter Health CA, United States
Phone:
Web Site:

Case Manager - Santa Rosa Manager Care

Job Summary
col-narrow
License: RN - Registered Nurse
Specialty: Case Management, General
Location: Santa Rosa, CA
Employment Type: Full time
Job Description
col-wide
At Sutter Health, our partnerships help us transform care. We are more than 50,000 professionals who are strengthened by compassion, inspired by innovation, and driven to excellence.  If you’re ready to add your abilities to our broad network of care, come realize your professional potential with Sutter Health.
 
Case Manager - Santa Rosa Managed Care
(80hr Days)
 
Sutter Pacific Medical Foundation is a not for profit corporation that exists to provide medical services, research and education. The foundation provides the infrastructure for the delivery of physician services, and contracts with a separate corporation comprised of physicians and other care providers to deliver the clinical services. This multi-specialty foundation will provide a platform from which new physicians can be recruited to continue to provide physician services in a nonprofit, community setting. The Foundation's vision is to create a medical group that will deliver high quality, market competitive medical services.
 
The Case Manager, RN is responsible for the identification of needs, evaluation and coordination of all health care services provided to Sutter Medical Group of the Redwoods managed care population. The Case Manager facilitates the arrangement and delivery of services throughout the continuum of care, while educating physicians and ancillary staff regarding the appropriate utilization of health care resources. The incumbent functions as a physician advisor with accountability to escalate cases to medical leadership as necessary. The Case Manager performs concurrent and retrospective review to determine the medical appropriateness of levels of care. The role is responsible for coordinating certain operations of Disease Management Programs.

Qualifications
Education Licensures and Certifications:
  • Graduate of an accredited school of nursing.
  • Current license as a registered nurse in the State of California
  • BSN preferred.
Experience:
  • Two-three years recent experience in Utilization Management/Case Management in acute setting or in a managed care setting, i.e., HMO or medical group required.
Skills and Knowledge:
  • NCQA standards and application, state and federal requirements as apply to managed care, utilization management criteria and its application, i.e., InterQual, Milliman & Robertson.
  • Ability to work independently, organize priorities and manage multiple assignments, excellent communication and interpersonal skills, critical thinking and problem-solving skills.
  • Computer experience is desirable.
 
To learn more and apply, please visit: https://jobs.sutterhealth.org/job/santa-rosa/case-manager-santa-rosa-managed-care-80hr-days/1099/4819541
 
Sutter Health Affiliates are Equal Opportunity Employers.  Sutter Health is an Equal Opportunity Employer (EOE M/F/D)
 
It is the policy of Sutter Health and its affiliates to provide equal employment for all qualified individuals; to prohibit discrimination in employment because of race, color, creed, religion, marital status, sex, sexual orientation, gender identity, ancestry, national origin, age, medical condition, disability or status as a veteran or a disabled veteran. We promote the full realization of equal employment opportunities through a positive continuing program within each company, hospital, department, and service area. Equal employment opportunities apply to every aspect of Sutter Health's employment policies and practices.
 


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