We are so glad you are interested in joining Sutter Health! **Organization:** CPMC-California Pacific Med Center Davies **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's accepted criteria for ambulatory, acute, and post-acute patients to confirm medical necessity is met and at the appropriate level of care. Coordinates the utilization management, resource management, discharge planning, post-acute care referrals and care facilitation. Strives to promote patient wellness, improved care outcomes, and efficient utilization of health services among a patient population with complex health needs. **Job Description** : **EDUCATION:** + Associate Degree in Nursing + Other: Graduate of an accredited school of nursing **CERTIFICATION & LICENSURE:** + RN-Registered Nurse of California + CCM - Certified Case Manager (certification may be required by entity and time to acquire within 2 years of hire) **TYPICAL EXPERIENCE:** + 2 years recent relevant experience **SKILLS AND KNOWLEDGE:** + A broad knowledge base 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 but not limited to: Centers for Medicare and Medicaid Services (GR) Grouper (CMS), Department of Managed Health Care, National Committee for Quality Assurance (NCQA). + A broad knowledge base of outpatient, acute, and post-acute levels of care and associated regulatory compliance requirements. + Must be able to effectively communicate with and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners. + Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families. + Demonstrates commitment to service excellence in all patients, family, and employee interactions and in performing all job responsibilities. + Functions in a manner to promote quality patient care and assure a positive patient experience. + Verbal and written communication skills. + Interpersonal communication and negotiation skills. + Must have time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities. + Intermediate computer skills. + Ability to promote teamwork and to effectively function in teams. + Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience. **Job Shift:** Days **Schedule:** Per Diem/Casual **Shift Hours:** 8 **Days of the Week:** Monday - Friday **Weekend Requirements:** None **Benefits:** No **Unions:** No **Position Status:** Non-Exempt **Weekly Hours:** 0 **Employee Status:** Per Diem/Casual Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $86.68 to $114.41 / hour _The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program. Eligible positions also include a comprehensive benefits package._