We are so glad you are interested in joining Sutter Health!
Organization:
PAMF-Palo Alto Medical Foundation PAD
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:
CERTIFICATION & LICENSURE:
TYPICAL EXPERIENCE:
- 2 years recent relevant experience
SKILLS AND KNOWLEDGE:
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A broad knowledge base of health care delivery and case management within a managed care environment.
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Comprehensive knowledge of Utilization Review, levels of care, and observation status.
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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).
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A broad knowledge base of outpatient, acute, and post-acute levels of care and associated regulatory compliance requirements.
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Must be able to effectively communicate with and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners.
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Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
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Demonstrates commitment to service excellence in all patients, family, and employee interactions and in performing all job responsibilities.
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Functions in a manner to promote quality patient care and assure a positive patient experience.
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Verbal and written communication skills.
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Interpersonal communication and negotiation skills.
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Must have time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities.
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Intermediate computer skills.
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Ability to promote teamwork and to effectively function in teams.
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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:
Full Time
Shift Hours:
8
Days of the Week:
Monday - Friday
Weekend Requirements:
None
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 $82.55 to $108.96 / 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.
