Case Manager
Roseville, California
Sutter Roseville Medical Center

Case Manager

Overview

• Travel/Contract role in Roseville, California
• 13-week assignment
• Day shift: 5x8 hours, 8:00–16:30
• Monday through Friday; no weekends; no call

Required Qualifications

• Associate of Science in Nursing / Associate Degree in Nursing
• Valid RN license in California
• Case Management (2 years of experience)
• Case Management experience within the last year
• Knowledge of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems
• Knowledge of post-acute levels of care and associated regulatory compliance requirements
• General understanding of coding and DRG assignment process
• Utilization Review (InterQual)
• Utilization Management

Preferred Qualifications

• Bachelor’s in Nursing
• Awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS, value-based reimbursement models, and alternative payment systems
• General understanding of coding and DRG assignment process

Skills and Knowledge

• Broad knowledge of health care delivery and case management within a managed care environment
• Comprehensive knowledge of Utilization Review, levels of care, and observation status
• Working knowledge of laws, regulations, and professional standards affecting case management practice in an integrated delivery system, including CMS, Title 22, CHA Consent Manual, CDPH, and TJC
• Broad knowledge of post-acute levels of care and associated regulatory compliance requirements
• Ability to communicate effectively and promote cooperation and collaboration with patients/families/caretakers, physicians, nurses, and other ancillary partners
• Ability to work independently and exercise sound judgment with physicians, payers, patients, and families
• Commitment to service excellence and quality patient care
• Strong verbal and written communication skills and negotiation skills
• Excellent time management skills in a high-volume environment with rapidly changing priorities
• Intermediate computer and technology skills
• Ability to promote teamwork and function effectively in teams
• Ability to interact effectively with internal and external constituents using collaboration and customer service skills