Case Manager, Health Plan

We are so glad you are interested in joining Sutter Health!

Organization:

Sutter Health Alliance - Valley

Position Overview:

Responsible for the coordination of services and cost effective management of health care resources to meet individual members' health care needs and promote positive health care outcomes. Case management responsibilities include assessment, coordination, planning, monitoring and evaluation of multiple environments, including referral into Disease Management, Complex Case Management or establishing and promoting the primary care medical home. Monitors and tracks members' that fall into one or more high risk or high cost groups who require significant clinical judgment, critical-thinking, clinical guidelines, community resources, contracting and community standards of care. Acts as a member advocate and liaison between providers, members and Sutter Health Plus to seamlessly integrate complex services.

Job Description:

EDUCATION:

• Graduate of an accredited school of nursing

CERTIFICATION & LICENSURE:

• RN-Registered Nurse of California

TYPICAL EXPERIENCE:

• 2 years recent relevant experience.

SKILLS AND KNOWLEDGE:

• Demonstrates knowledge of HIPAA, Health Care Reform, Business Code of Ethics and government regulated programs.
• Demonstrated ability to work collaboratively, prioritize functions, problem solve, and anticipate upcoming issues for the executives.
• Oral and written communication skills.
• Telephone skills managing escalated calls.
• Abilities with Microsoft Word, Excel and PowerPoint, internet research.
• Must require minimal supervision.
• Understanding of compliance and quality programs.
• Knowledge of preventive health standards for adults and pediatrics, understands NCQA standards, as well as HEDIS, CAHPs, ICE Tools.
• Must be able to positively interact with clinicians, senior management, members and all levels of clinical and non-clinical professionals in the provider office, medical group, health plan and regulatory agencies.

 

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Friday, Monday, Thursday, Tuesday, Wednesday

Weekend Requirements:

Occasionally

Benefits:

Yes

Unions:

No

Position Status:

Non-Exempt

Weekly Hours:

40

Employee Status:

Regular

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $78.91 to $103.37 / 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.